Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials
Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials
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DOI：
10.1093/bja/aep279
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发表时间：
2009-11-01
影响因子：
9.8
通讯作者：
Brienza, N.
中科院分区：
文献类型：
--
作者：
Giglio, M. T.;Marucci, M.;Brienza, N.
术后胃肠功能障碍是外科手术患者最常见的并发症之一。大多数病例与低血容量或心功能不全引起的内脏灌注不足有关。有人认为，围手术期血流动力学目标导向治疗（GDT）可以减少心脏手术和其他手术中这些并发症的发生率，但缺乏明确的证据。我们对GDT对术后胃肠道和肝脏并发症的影响进行了荟萃分析。使用MEDLINE、EMBASE和科克伦图书馆数据库进行系统检索。16项随机对照试验（3410例受试者）符合纳入标准。通过随机效应模型，使用比值比（OR）和95%置信区间（CI）获得数据综合。通过Q和I-2统计评估统计异质性。胃肠道并发症分为严重（需要放射或手术干预或危及生命的情况）或轻微（不需要或仅需要药物治疗）。与对照组相比，GDT显著降低了严重GI并发症（OR，0.42; 95%CI，0.27-0.65）。GDT组的轻微胃肠道并发症也显著减少（OR，0.29; 95% CI，0.17-0.50）。治疗未降低肝损伤发生率（OR，0.54; 95% CI，0.19-1.55）。质量敏感性分析证实了主要的总体结果。在接受大手术的患者中，GDT通过维持充分的全身氧合，可以保护器官，特别是处于围手术期灌注不足风险的器官，并有效减少GI并发症。
Postoperative gastrointestinal (GI) dysfunction is one of the most frequent complications in surgical patients. Most cases are associated with episodes of splanchnic hypoperfusion due to hypovolaemia or cardiac dysfunction. It has been suggested that perioperative haemodynamic goal-directed therapy (GDT) may reduce the incidence of these complications in cardiac surgery, and other surgery, but clear evidence is lacking. We have undertaken a meta-analysis of the effects of GDT on postoperative GI and liver complications. A systematic search, using MEDLINE, EMBASE, and The Cochrane Library databases, was performed. Sixteen randomized controlled trials (3410 participants) met the inclusion criteria. Data synthesis was obtained using odds ratio (OR) with 95% confidence interval (CI) by random-effects model. Statistical heterogeneity was assessed by Q and I-2 statistics. GI complications were ranked as major (required radiological or surgical intervention or life-threatening condition) or minor (no or only pharmacological treatment required). Major GI complications were significantly reduced by GDT when compared with a control group (OR, 0.42; 95% CI, 0.27-0.65). Minor GI complications were also significantly decreased in the GDT group (OR, 0.29; 95% CI, 0.17-0.50). Treatment did not reduce hepatic injury rate (OR, 0.54; 95% CI, 0.19-1.55). Quality sensitive analyses confirmed the main overall results. In patients undergoing major surgery, GDT, by maintaining an adequate systemic oxygenation, can protect organs particularly at risk of perioperative hypoperfusion and is effective in reducing GI complications.