术前及围手术期肺康复护理方案对胸外科手术患者管理的有效性：一项系统评价和荟萃分析

Effectiveness of preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery: A systematic review and meta-analysis.

作者信息

Xu Ming, Yang Xiaoqin, Guo Lingyan

机构信息

Ming Xu, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, 507 Zhengmin Road, Shanghai 200439, P.R. China.

Xiaoqin Yang, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, 507 Zhengmin Road, Shanghai 200439, P.R. China.

出版信息

Pak J Med Sci. 2024 Jul;40(6):1280-1286. doi: 10.12669/pjms.40.6.9259.

DOI:10.12669/pjms.40.6.9259

PMID:38952505

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11190427/

Abstract

BACKGROUND & OBJECTIVE: Several studies have investigated the effectiveness of preoperative or perioperative pulmonary rehabilitation in thoracic surgery patients, but the results are inconsistent and inconclusive. This study attempts to summarize the existing data on the effect of the preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery.

METHODS

Systematic search was done in PubMed Central, SCOPUS, EMBASE, MEDLINE, Google Scholar, and ScienceDirect for papers published until December 2022 and reporting data of postoperative complications and pulmonary health status in patients undergoing thoracic surgery and receiving preoperative or perioperative pulmonary rehabilitation nursing intervention or standard care. Meta-analysis was done by random-effects model and pooled standardised mean differences (SMD) or odds ratios (OR) along with 95% confidence intervals (CIs) were reported.

RESULTS

Eighteen studies were included and analysed. Pooled SMD was 0.44 (95%CI: -0.21 to 1.08) for forced expiratory volume (FEV-1), -0.34 (95%CI: -0.94 to 0.26) for peak expiratory flow (PEF), 0.61 (95%CI: -0.60 to 1.81) for forced vital capacity (FVC), 0.42 (95%CI: -0.13 to 0.98) for diffusing capacity of carbon monoxide (DLCO). Pooled SMD for length of hospital stay was -0.64 (95%CI: -1.09 to -0.19). Pooled OR was 0.87 [95%CI: 0.32 to 2.37] for all-cause mortality, 0.35 [95%CI: 0.25 to 0.50] for postoperative pulmonary complications, 0.98 [95%CI: 0.45 to 2.12] for respiratory failure, 0.52 [95%CI: 0.38 to 0.78] for pneumonia and 0.50 [95%CI: 0.33 to 0.76] for atelectasis.

CONCLUSION

Perioperative pulmonary rehabilitation nursing program is effective in reducing the postoperative lung complications and shortening the length of hospital stay in patients undergoing thoracic surgery.

摘要

背景与目的

多项研究探讨了术前或围手术期肺康复对胸外科手术患者的有效性，但结果并不一致且尚无定论。本研究旨在总结术前和围手术期肺康复护理方案对胸外科手术患者管理效果的现有数据。

方法

在PubMed Central、SCOPUS、EMBASE、MEDLINE、谷歌学术和ScienceDirect中进行系统检索，查找截至2022年12月发表的、报告接受术前或围手术期肺康复护理干预或标准护理的胸外科手术患者术后并发症和肺健康状况数据的论文。采用随机效应模型进行荟萃分析，并报告合并标准化均数差（SMD）或比值比（OR）以及95%置信区间（CI）。

结果

纳入并分析了18项研究。用力呼气量（FEV-1）的合并SMD为0.44（95%CI：-0.21至1.08），呼气峰值流速（PEF）为-0.34（95%CI：-0.94至0.26），用力肺活量（FVC）为0.61（95%CI：-0.60至1.81），一氧化碳弥散量（DLCO）为0.42（95%CI：-0.13至0.98）。住院时间的合并SMD为-0.64（95%CI：-1.09至-0.19）。全因死亡率的合并OR为0.87 [95%CI：0.32至2.37]，术后肺部并发症为0.35 [95%CI：0.25至0.50]，呼吸衰竭为0.98 [95%CI：0.45至2.12]，肺炎为0.52 [95%CI：0.38至0.78]，肺不张为0.50 [95%CI：0.33至0.76]。