探索接受度和坚持度在接受大型腹部手术的患者中进行术前和术后康复治疗：系统评价和荟萃分析。
Exploring the acceptability of and adherence to prehabilitation and rehabilitation in patients undergoing major abdominal surgery: A systematic review and meta-analysis.
机构信息
Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; Department of Clinical Nutrition, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia. Electronic address: https://twitter.com/AbdulAz1z4_4.
Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; University of Defence, Military Faculty of Medicine, Department of Military Internal Medicine and Military Hygiene, Hradec Kralove, Czech Republic; 3rd Department of Internal Medicine-Metabolic Care and Gerontology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic. Electronic address: https://twitter.com/Pavel_Skorepa_.
出版信息
Clin Nutr ESPEN. 2024 Oct;63:709-726. doi: 10.1016/j.clnesp.2024.07.1060. Epub 2024 Aug 13.
BACKGROUND AND AIMS
Prehabilitation combines exercise, nutritional, and psychological interventions administered before surgery to improve patient outcomes. This comprehensive review and meta-analysis examined the feasibility, adherence, and effectiveness of prehabilitation in frail, high-risk individuals undergoing major abdominal surgery.
METHODS
We searched the Cochrane Central Register of Controlled Trials, Web of Science, MEDLINE, Embase, and Cumulative Index to Nursing & Allied Health Literature (CINAHL) databases to identify relevant studies evaluating prehabilitation programs published between 2010 and 2023, either as observational studies or randomized clinical trials (RCTs).
RESULTS
The 23 articles (13 RCTs and 10 observational studies) included 1849 older male and female patients aged 68.7 ± 7.2 years. Nineteen of the included studies reported on adherence to prehabilitation programmes, which was generally good (>75%) over different models, settings, and durations. Factors such as patients' desire for expedited surgery, self-assessment of fitness, personal and professional obligations, health issues, holidays, and advancement of surgery dates negatively affected adherence to prehabilitation programmes. When compared with rehabilitation or standard pre- and post-surgical care, prehabilitation was associated with a 25%, albeit not statistically significant reduction in postoperative complications, according to data from 14 studies reporting on postoperative complications (OR 0.75, 95% CI 0.48 to 1.17, P = 0.43; I = 65%). Prehabilitation has been found to improve the 6-min walk test significantly by 29.4 m (MD +29.4 m, 95% CI 5.6 to 53.3, P = 0.02; I = 39%), compared with rehabilitation or standard pre- and post-surgical care.
CONCLUSION
Prehabilitation was acceptable to patients, with good adherence, and improved physical function.
背景和目的
术前综合运用运动、营养和心理干预措施的预康复，可以改善患者的结局。本项全面的综述和荟萃分析旨在考察预康复在接受大型腹部手术的虚弱、高危个体中的可行性、依从性和有效性。
方法
我们检索了 Cochrane 对照试验中心注册库、Web of Science、MEDLINE、Embase 和 Cumulative Index to Nursing & Allied Health Literature（CINAHL）数据库，以确定 2010 年至 2023 年间发表的评估预康复方案的相关研究，这些研究为观察性研究或随机临床试验（RCT）。
结果
23 篇文章（13 项 RCT 和 10 项观察性研究）纳入了 1849 名年龄为 68.7±7.2 岁的老年男性和女性患者。纳入的 19 项研究报告了预康复方案的依从性，不同模式、环境和持续时间下的依从性通常较好（>75%）。患者对尽快手术的愿望、对自身健康状况的自我评估、个人和职业义务、健康问题、休假以及手术日期的提前等因素对预康复方案的依从性产生了负面影响。与康复或标准术前和术后护理相比，14 项报告术后并发症的研究表明，预康复与术后并发症减少 25%相关（OR 0.75，95%CI 0.48 至 1.17，P=0.43；I²=65%）。与康复或标准术前和术后护理相比，预康复被发现可使 6 分钟步行测试显著提高 29.4 米（MD+29.4 米，95%CI 5.6 至 53.3，P=0.02；I²=39%）。
结论
预康复被患者接受，具有较好的依从性，并改善了身体功能。
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