Department of Anesthesiology, Hebei General Hospital, No.348, Heping West Road, Shijiazhuang, 050051, China.
Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, No.16, Tangu North Street, Shijiazhuang, 050051, China.
J Cardiothorac Surg. 2024 Feb 5;19(1):60. doi: 10.1186/s13019-024-02519-y.
Pulmonary complications after thoracic surgery are common and associated with significant morbidity and high cost of care. Goal-directed fluid therapy (GDFT) could reduce the incidence of postoperative pulmonary complications (PPCs) and facilitate recovery in patients undergoing major abdominal surgery. However, whether GDFT could reduce the incidence of PPCs in patients undergoing thoracic surgery was unclear. The present meta-analysis was designed to assess the impact of Goal-directed Fluid Therapy on PPCs in patients undergoing thoracic surgery.
Randomized controlled trials (RCTs) comparing GDFT with other conventional fluid management strategies in adult patients undergoing thoracic surgery were identified. Databases searched included PubMed, Web of Science, Embase, and Cochrane Library databases. Review Manager 5.4 (The Cochrane Collaboration, Oxford, UK) software was used for statistical analysis. Heterogeneity was analyzed using I statistics, and a standardized mean difference with 95% CI and P value was used to calculate the treatment effect for outcome variables. The primary study outcomes were the incidence of PPCs. Secondary outcomes were the total volume infused, the length of hospitalization, the incidence of cardiac complications, and the incidence of renal dysfunction. Subgroup analysis was planned to verify the definite role of GDFT.
A total of 6 RCTs consisting of 680 patients were included in this meta-analysis, which revealed that GDFT did not reduce the incidence of PPCs in patients undergoing thoracic surgery (RR, 0.57; 95% CI 0.29-1.14). However, GDFT decreased the total intra-operative fluid input (MD, - 244.40 ml; 95% CI - 397.06 to - 91.74). There was no statistical difference in the duration of hospitalization (MD; - 1.31, 95% CI - 3.00 to 0.38), incidence of renal dysfunction (RR, 0.62; 95% CI 0.29-1.35), and incidence of cardiac complications (RR, 0.62; 95% CI 0.27-1.40).
The results of this meta-analysis indicate that GDFT did not reduce the postoperative incidence of pulmonary complications in individuals undergoing thoracic surgery. However, considering the small number of contributing studies, these results should be interpreted with caution.
胸外科手术后的肺部并发症很常见，并且与显著的发病率和高医疗费用相关。目标导向的液体治疗（GDFT）可以降低腹部大手术后患者术后肺部并发症（PPC）的发生率，并促进患者的康复。然而，GDFT 是否可以降低接受胸外科手术的患者肺部并发症的发生率尚不清楚。本荟萃分析旨在评估目标导向的液体治疗对接受胸外科手术的患者肺部并发症的影响。
检索了PubMed、Web of Science、Embase 和 Cochrane Library 数据库，以确定比较 GDFT 与其他常规液体管理策略在成人接受胸外科手术中的随机对照试验（RCT）。使用 Review Manager 5.4（Cochrane 协作组织，牛津，英国）软件进行统计分析。使用 I 统计量分析异质性，并使用标准化均数差（SMD）及其 95%置信区间（CI）和 P 值来计算结局变量的治疗效果。主要研究结局为 PPCs 的发生率。次要结局为总输液量、住院时间、心脏并发症发生率和肾功能障碍发生率。计划进行亚组分析以验证 GDFT 的明确作用。
共有 6 项 RCT 纳入了本荟萃分析，共 680 名患者，结果表明 GDFT 并不能降低接受胸外科手术的患者 PPCs 的发生率（RR，0.57；95%CI，0.29-1.14）。然而，GDFT 减少了术中总液体输入量（MD，-244.40ml；95%CI，-397.06 至-91.74）。住院时间（MD；-1.31，95%CI，-3.00 至 0.38）、肾功能障碍发生率（RR，0.62；95%CI，0.29-1.35）和心脏并发症发生率（RR，0.62；95%CI，0.27-1.40）均无统计学差异。
本荟萃分析的结果表明，GDFT 不能降低接受胸外科手术的个体术后肺部并发症的发生率。然而，鉴于纳入研究的数量较少，这些结果应谨慎解释。
