择期手术术前禁食新指南的临床效果及安全性：一项系统评价与荟萃分析
The clinical effect and safety of new preoperative fasting time guidelines for elective surgery: a systematic review and meta-analysis.
作者信息
He Yuying, Wang Rongrong, Wang Fei, Chen Lili, Shang Tingting, Zheng Luya
机构信息
Operating Room, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
Nursing Department, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
出版信息
Gland Surg. 2022 Mar;11(3):563-575. doi: 10.21037/gs-22-49.
BACKGROUND
Traditional fasting and no drinking schemes (fasting for 8-12 hours and no drinking for 4-6 hours) affect the metabolism of the body. The new guidelines put forward by the American Association of Anesthesiologists (fasting for 6 hours, no drinking for 2 hours) obviously reduce the time of fasting and no drinking, but the clinical efficacy and safety need to be further confirmed. In this study, a meta-analysis of randomized controlled trials (RCTs) using the new guidelines and traditional protocols was conducted to provide an evidence-based foundation for elective surgery.
METHODS
The articles were searched in PubMed, EBSCO, MEDLINE, Science Direct, Cochrane Library, CNKI, China Biomedical Resources Database, Wanfang Database, Weipu, and Western Biomedical Journal Literature Database. RCTs related to fasting before surgery during the screening period were selected. Chinese and English search keywords included elective surgery, preoperative, fasting and no drinking, patient comfort, thirst, hunger, collapse, hypoglycemia, preoperative gastric volume, preoperative gastric juice pH, and intraoperative gastric volume. The RevMan 5.3 software provided by Cochrane collaboration network was used to evaluate the quality of included documents. Two professionals independently screened the literature, extracted data, and assessed the risk of bias.
RESULTS
A total of 6 studies were included. The incidence of hunger in patients undergoing elective surgery in the experimental group and control group was significantly different [Z=3.90; relative risk (RR) =0.58; 95% confidence interval (CI): 0.44, 0.76; P<0.0001]. The incidence of thirst was significantly different between the experimental group and control group (Z=7.22; RR =0.21; 95% CI: 0.13, 0.32; P<0.00001).
DISCUSSION
Meta-analysis results confirmed that the new guidelines can significantly reduce the hunger and thirst of patients, improve their satisfaction after surgery, and can be applied clinically.
背景
传统禁食禁饮方案（禁食8 - 12小时、禁饮4 - 6小时）影响机体代谢。美国麻醉医师协会提出的新指南（禁食6小时、禁饮2小时）明显缩短了禁食禁饮时间，但临床疗效及安全性尚需进一步证实。本研究通过对采用新指南和传统方案的随机对照试验（RCT）进行荟萃分析，为择期手术提供循证依据。
方法
检索PubMed、EBSCO、MEDLINE、Science Direct、Cochrane图书馆、中国知网、中国生物医学文献数据库、万方数据库、维普以及西文生物医学期刊文献数据库中的文章。筛选筛查期内与术前禁食相关的RCT。中英文检索关键词包括择期手术、术前、禁食禁饮、患者舒适度、口渴、饥饿、虚脱、低血糖、术前胃容量、术前胃液pH值及术中胃容量。采用Cochrane协作网提供的RevMan 5.3软件评估纳入文献的质量。两名专业人员独立筛选文献、提取数据并评估偏倚风险。
结果
共纳入6项研究。试验组和对照组择期手术患者的饥饿发生率差异有统计学意义[Z = 3.90；相对危险度（RR）= 0.58；95%置信区间（CI）：0.44，0.76；P < 0.0001]。试验组和对照组的口渴发生率差异有统计学意义（Z = 7.22；RR = 0.21；95% CI：0.13，0.32；P < 0.00001）。
讨论
荟萃分析结果证实，新指南可显著降低患者的饥饿和口渴感，提高术后满意度，可临床应用。
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