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围术期应用血管活性药物对腹部大手术患者的术后影响：系统回顾与meta分析
翻译：佟睿 编辑：冯玉蓉 审校：曹莹
背景：临床麻醉中血管活性药物应用普遍，然而其药物种类、剂量及血流动力学目标却各不相同。本项研究旨在探讨围术期使用血管活性药物能否降低接受腹部大手术的成年患者（16岁及以上）的死亡率、发病率和住院时间。
方法：在MEDLINE、EMBASE及Cochrane对照试验登记中心搜索经同行评审的、涵盖评估术中血管活性药物使用情况研究的随机对照试验（不限语言及日期）。我们进行了标题、摘要和全文筛选，并对每项结果进行了测量偏倚的评估。运用具有相应95% CI的Mantele-Haenszel随机效应模型计算二分类结果的风险比率（RR），并采用具有相应95%CI的逆方差随机效应模型计算连续结果的平均差。
结果：本次分析共纳入26项试验、5561名参与者。在最长的随访中，患者术后死亡率无差异；RR：0.84（95% CI: 0.63－1.12; P＝0.23）。干预组发生一种及以上术后并发症的患者人数明显降低；RR：0.76（95% CI: 0.66－0.88; P＝0.0002）。干预组的住院时间减少0.91天。
结论：由于个别研究的质量、样本量以及环境、干预措施和结果测量的异质性，本项回顾性研究受到一定限制。围术期使用血管活性药物可减少成年患者腹部大手术的术后并发症和住院时间。
原始文献来源：DengC,BellomoR,MylesP. Systematic review and meta-analysis of the perioperative use of vasoactive drugs on postoperative outcomes after major abdominal surgery.[J].Br J Anaesth May; 124(5): 513-524.
Systematic review and meta-analysis of the perioperative use of vasoactive drugs on postoperative outcomes after major abdominal surgery
Abstract
Background:The perioperative use of vasoactive drugs is ubiquitous in clinical anaesthesia; yet, the drugs, doses, and haemodynamic targets used are highly variable. Our objectives were to determine whether the perioperative administration of vasoactive drugs reduces mortality, morbidity, and length of stay in adult patients (aged 16 yr or older) undergoing major abdominal surgery.
Methods:MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for peer-reviewed RCTs with no language or date restrictions. Studies that assessed the intraoperative use of vasoactive drugs were included. Title, abstract, and full-text screening was performed. Risk of bias for each outcome measure was conducted. We calculated the risk ratio (RR) using the Mantele-Haenszel random-effects model with corresponding 95% confidence interval (CI) for dichotomous outcomes, and mean difference using the inverse variance random-effects model with corresponding 95% CI for continuous outcomes.
Results:Twenty-six studies (5561 participants) were included. There was no difference in mortality at the longest followup with an RR of 0.84 (95% CI: 0.63－1.12; P＝0.23). The intervention significantly reduced the number of patients with one or more postoperative complications; RR: 0.76 (95% CI: 0.66－0.88; P＝0.0002). Hospital length of stay was reduced by 0.91 days in the intervention group.
Conclusions:This review is limited by the quality and sample size of individual studies, and the heterogeneity of the settings, interventions, and outcome measures. Perioperative administration of vasoactive drugs may reduce postoperative complications and hospital length of stay in adult patients having major abdominal surgery. Keywords: cardiovascular agents; goal-directed therapy; haemodynamics; major abdominal surgery; perioperative care; vasoconstrictor agents
贵州医科大学高鸿教授课题组
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