Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Gastrointest Surg. 2021 Jun;25(6):1601-1624. doi: 10.1007/s11605-021-04973-8. Epub 2021 Mar 25.
Postoperative ileus (POI) remains a common complication following bowel resection. Selective opioid antagonists have been increasingly studied as prophylactic pharmaceutical aids to reduce rates of POI. The aim of this study was to evaluate the impact of selective opioid antagonists on return of bowel function following bowel resection.
MEDLINE, Embase, and CENTRAL were systematically searched. Articles were included if they compared the incidence of POI and/or length of stay (LOS) in patients receiving and not receiving selective opioid antagonists following elective bowel resection. A pairwise meta-analyses using inverse variance random effects was performed.
From 636 citations, 30 studies with 45,051 patients receiving selective opioid antagonists (51.3% female, mean age: 60.9) and 55,071 patients not receiving selective opioid antagonists (51.2% female, mean age: 61.1) were included. Patients receiving selective opioid antagonists had a significantly lower rate of POI (10.1% vs. 13.8%, RR 0.68, 95%CI 0.63-0.75, p < 0.01). Selective opioid antagonists also significantly reduced LOS (MD - 1.08, 95%CI - 1.47 to - 0.69, p < 0.01), readmission (RR 0.94, 95%CI 0.89-0.99, p = 0.03), and 30-day morbidity (RR 0.85, 95%CI 0.79-0.90, p < 0.01). Improvements in LOS, readmission rate, and morbidity were not significant when analysis was limited to laparoscopic surgery. There was no significant difference in inpatient healthcare costs (SMD - 0.33, 95%CI - 0.71-0.04, p = 0.08).
Rate of POI decreases with the use of selective opioid antagonists in patients undergoing bowel resection. Selective opioid antagonists also improve LOS, rates of readmission, and 30-day morbidity for patients undergoing open bowel resection. Addition of these medications to enhance recovery after surgery protocols should be considered.
术后肠梗阻（POI）仍然是肠切除术后的常见并发症。选择性阿片受体拮抗剂作为预防药物辅助手段，已被越来越多地研究用于降低 POI 的发生率。本研究旨在评估选择性阿片受体拮抗剂对肠切除术后肠功能恢复的影响。
系统检索 MEDLINE、Embase 和 CENTRAL。纳入比较接受和不接受选择性阿片受体拮抗剂的择期肠切除术后患者 POI 发生率和/或住院时间（LOS）的研究。采用倒数方差随机效应进行成对荟萃分析。
从 636 条引文，纳入 30 项研究，共 45051 例接受选择性阿片受体拮抗剂的患者（51.3%为女性，平均年龄：60.9 岁）和 55071 例未接受选择性阿片受体拮抗剂的患者（51.2%为女性，平均年龄：61.1 岁）。接受选择性阿片受体拮抗剂的患者 POI 发生率显著降低（10.1%比 13.8%，RR 0.68，95%CI 0.63-0.75，p < 0.01）。选择性阿片受体拮抗剂还显著缩短 LOS（MD -1.08，95%CI -1.47 至 -0.69，p < 0.01）、再入院率（RR 0.94，95%CI 0.89-0.99，p = 0.03）和 30 天发病率（RR 0.85，95%CI 0.79-0.90，p < 0.01）。当分析仅限于腹腔镜手术时，LOS、再入院率和发病率的改善无显著差异。住院医疗费用无显著差异（SMD -0.33，95%CI -0.71-0.04，p = 0.08）。
在接受肠切除的患者中，使用选择性阿片受体拮抗剂可降低 POI 的发生率。选择性阿片受体拮抗剂还可改善开放性肠切除术后患者的 LOS、再入院率和 30 天发病率。在手术后恢复方案中添加这些药物以增强恢复应予以考虑。
