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手术后加速康复(ERAS)方案在急诊结直肠手术中的疗效:与传统护理在结局和并发症方面的荟萃分析比较

Efficacy of Enhanced Recovery After Surgery (ERAS) Protocols in Emergency Colorectal Surgery: A Meta-Analytical Comparison With Conventional Care in Terms of Outcomes and Complications.

作者信息

Ahmed Adeel, Khalid Sadaf, Sharif Gul, Ahmed Hajrah Hilal, Khattak Imtiaz Ahmed, Memon Sara Khalid

机构信息

Internal Medicine, District Head Quarters (DHQ) Teaching Hospital, Gujranwala, PAK.

General Surgery, Royal Free Hospital, London, GBR.

出版信息

Cureus. 2024 Oct 16;16(10):e71630. doi: 10.7759/cureus.71630. eCollection 2024 Oct.

Abstract

The "Enhanced Recovery After Surgery" (ERAS) strategy, a patient-centered, evidence-based approach, aims to reduce surgical stress, maintain physiological function, and expedite recovery. Initially developed for elective surgeries, particularly colorectal procedures, ERAS protocols are now being explored for their potential benefits in the more challenging context of emergency surgeries. The current investigation aims to identify the most useful ERAS components in emergency surgery scenarios by comparing postoperative recovery times, possible health outcomes of patients, and complication rates. Through August 2023, extensive searches were conducted in the Cochrane Library, MEDLINE, EMBASE, and PubMed databases. Data were taken from nine RCTs, which were prospective and retrospective cohort studies and were used to derive important outcomes. The Cochrane Risk of Bias tool was employed to measure the caliber of research. Effect pooling estimates were estimated using random-effects models. For the investigations, STATA version 16.0 and Review Manager (RevMan) version 5.4 were used. Nine studies that addressed the range of ERAS components and outcomes were included. Compared to standard treatment, ERAS procedures generally showed faster postoperative recovery durations. Studies' success or adherence rates differed. Subgroup analyses were necessary due to significant heterogeneity in order to determine potential sources. For emergency colorectal procedures, ERAS methods shorten postoperative recovery periods when appropriately modified and put into practice. However, varying success rates throughout studies showed that, in order to maximize and standardize ERAS protocols for comprehensive advantages, significant thought and further study are required. The meta-analysis suggests that ERAS protocols offer substantial benefits in emergency colorectal surgeries, particularly in reducing postoperative recovery times and complication rates.

摘要

“术后加速康复”(ERAS)策略是一种以患者为中心、基于证据的方法,旨在减轻手术应激、维持生理功能并加速康复。ERAS方案最初是为择期手术,特别是结直肠手术而制定的,目前正在探讨其在更具挑战性的急诊手术背景下的潜在益处。当前的调查旨在通过比较术后恢复时间、患者可能的健康结果和并发症发生率,确定急诊手术场景中最有用的ERAS组成部分。截至2023年8月,在考克兰图书馆、MEDLINE、EMBASE和PubMed数据库中进行了广泛检索。数据来自9项随机对照试验,这些试验为前瞻性和回顾性队列研究,用于得出重要结果。采用考克兰偏倚风险工具来衡量研究质量。使用随机效应模型估计效应合并估计值。在调查中,使用了STATA 16.0版和Review Manager(RevMan)5.4版。纳入了9项涉及ERAS组成部分和结果范围的研究。与标准治疗相比,ERAS程序通常显示出术后恢复时间更快。各研究的成功率或依从率有所不同。由于存在显著异质性,需要进行亚组分析以确定潜在来源。对于急诊结直肠手术,ERAS方法经过适当修改并付诸实践后可缩短术后恢复期。然而,各研究的成功率各不相同,这表明为了使ERAS方案的综合优势最大化并标准化,需要进行深入思考和进一步研究。荟萃分析表明,ERAS方案在急诊结直肠手术中具有显著益处,特别是在缩短术后恢复时间和降低并发症发生率方面。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f41/11566948/3502ee2764d9/cureus-0016-00000071630-i01.jpg

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