Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
Am J Surg. 2024 Oct;236:115857. doi: 10.1016/j.amjsurg.2024.115857. Epub 2024 Jul 18.
Enhanced recovery after surgery (ERAS) protocols are an evidence-based, multidisciplinary, and systematic approach to peri-operative care, which attempt to reduce the anticipated physiological strain on patients after major surgery. This meta-analysis of randomised clinical trials (RCTs) evaluated the impact of ERAS following emergency laparotomy versus standard care.
A systematic review was performed as per PRISMA guidelines. Meta-analysis was performed using RevMan v5.4.
Six RCTs involving 509 patients were included. Patients randomised to ERAS had reduced post-operative nausea and vomiting (PONV) (odds ratio (OR): 0.32, 95 % confidence interval (CI): 0.20-0.51), time to ambulation (mean difference (MD): 1.67, 95 % CI: -2.56 to -0.78) and bowel opening (MD: -1.26, 95 % CI: -2.03 to -0.49), length of stay (LOS) (MD: -2.92 95 % CI: -3.73 - - 2.10), pulmonary complications (OR: 0.43, 95 % CI: 0.24-0.75), surgical site (OR: 0.33 95 % CI: 0.2-0.50) and urinary tract infections (OR: 0.48 95 % CI: 0.19-1.16).
ERAS successfully reduced patient recovery, LOS, and complications. ERAS protocols should be deployed, where feasible, for emergency laparotomy.
手术后加速康复（ERAS）方案是一种基于证据的、多学科的、系统的围手术期护理方法，旨在减少大手术后患者预期的生理应激。本项随机临床试验（RCT）的荟萃分析评估了与标准护理相比，在急诊剖腹手术后实施 ERAS 的效果。
按照 PRISMA 指南进行系统评价。使用 RevMan v5.4 进行荟萃分析。
纳入了 6 项涉及 509 名患者的 RCT。接受 ERAS 的患者术后恶心和呕吐（PONV）减少（比值比（OR）：0.32，95%置信区间（CI）：0.20-0.51），下床活动时间（MD：1.67，95%CI：-2.56 至-0.78）和肠道通气时间（MD：-1.26，95%CI：-2.03 至-0.49），住院时间（MD：-2.92，95%CI：-3.73 至-2.10），肺部并发症（OR：0.43，95%CI：0.24-0.75），手术部位（OR：0.33，95%CI：0.20-0.50）和尿路感染（OR：0.48，95%CI：0.19-1.16）。
ERAS 成功地减少了患者的恢复时间、住院时间和并发症。应在可行的情况下，在急诊剖腹术中应用 ERAS 方案。
