上腹部手术的多模式预稳定和术后结果：系统评价和荟萃分析-动脉网

Multimodal prehabilitation and postoperative outcomes in upper abdominal surgery: systematic review and meta-analysis

Nature 等信源发布 2024-07-11 20:08

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AbstractThe impact of multimodal prehabilitation on postoperative complications in upper abdominal surgeries is understudied. This review analyzes randomized trials on multimodal prehabilitation with patient and hospital outcomes. MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched for trials on prehabilitation before elective (non-emergency) abdominal surgery.

摘要多模式康复对上腹部手术术后并发症的影响尚未得到充分研究。本综述分析了多模式康复与患者和医院结局的随机试验。MEDLINE，Embase，CINAHL和Cochrane CENTRAL在选择性（非紧急）腹部手术前进行了康复试验。

Two reviewers independently screened studies, extracted data, and assessed study quality. Primary outcomes of interest were postoperative pulmonary complications (PPCs) and all-cause complications; secondary outcomes included hospital and intensive care length of stay. A meta-analysis with random-effect models was performed, and heterogeneity was evaluated with I-square and Cochran’s Q test.

两位评价者独立筛选研究，提取数据并评估研究质量。感兴趣的主要结果是术后肺部并发症（PPC）和全因并发症；次要结果包括住院和重症监护住院时间。使用随机效应模型进行荟萃分析，并使用I平方和Cochran Q检验评估异质性。

Dichotomous variables were reported in log-odds ratio and continuous variables were presented as mean difference. Ten studies (total 1503 patients) were included. Odds of developing complications after prehabilitation were significantly lower compared to various control groups (− 0.38 [− 0.75– − 0.004], P = 0.048).

以对数优势比报告二分变量，连续变量表示为平均差异。纳入了十项研究（共1503名患者）。与各种对照组相比，康复后发生并发症的几率显着降低（0.38[-0.75-0.004]，P=0.048）。

Five studies described PPCs, and participants with prehabilitation had decreased odds of PPC (− 0.96 [− 1.38– − 0.54], P < 0.001). Prehabilitation did not significantly reduce length of stay, unless exercise was implemented; with exercise, hospital stay decreased significantly (− 0.91 [− 1.67– − 0.14], P = 0.02).

五项研究描述了PPC，康复参与者的PPC几率降低（0.96[--1.38--0.54]，P<0.001）。除非进行锻炼，否则康复并没有显着缩短住院时间；随着运动的进行，住院时间显着下降（0.91[-1.67-0.14]，P=0.02）。

Multimodal prehabilitation may decrease complications in upper abdominal surgery, but not necessarily length of stay; research should address heterogeneity in the literature..

多模式康复可能会减少上腹部手术的并发症，但不一定是住院时间；研究应该解决文献中的异质性。。

IntroductionMore than four of 10 adults over the age of 60 in the United States will undergo intra-abdominal surgery during their lifetime1, 30% of whom are expected to experience postoperative complications. Major abdominal surgeries are often complex, involving extensive incisions, manipulations of intra-abdominal internal organs, and digestive resections with reconstruction via anastomosis or stoma creation2.Patients undergoing major abdominal surgery, especially upper abdominal surgery, are predisposed to postoperative pulmonary complications (PPCs)3,4,5,6 due to compromised pulmonary mechanics caused by multiple factors.

引言美国60岁以上的10名成年人中有4名以上将在其一生中接受腹腔手术1，其中30%预计会出现术后并发症。腹部大手术通常很复杂，涉及广泛的切口，腹腔内内脏器官的操作以及通过吻合或造口重建的消化道切除2。接受腹部大手术，尤其是上腹部手术的患者，由于多种因素引起的肺力学受损，易患术后肺部并发症（PPCs）3,4,5,6。

First, the residual effects of combined anesthetic and neuromuscular blocking agents result in hypoventilation7. Second, these extensive laparotomy incisions extend to the sternum causing splinting of the diaphragm from pain, accompanied by shallow breathing and inadequate cough, leading to retention of secretions and subsequently atelectasis and pneumonia8,9.

首先，联合麻醉剂和神经肌肉阻滞剂的残余作用导致通气不足7。其次，这些广泛的剖腹手术切口延伸到胸骨，导致膈肌疼痛夹板，伴有浅呼吸和咳嗽不足，导致分泌物潴留，随后出现肺不张和肺炎8,9。

These factors contribute to postoperative respiratory failure—a combination of hypoxemic and hypercapnic respiratory failure4,10,11.These outcomes delay return to normal quality of life12, exacting a psychosocial toll on patient-family units13, while placing a significant financial burden on healthcare systems14.

这些因素导致术后呼吸衰竭-低氧血症和高碳酸血症呼吸衰竭的组合4,10,11。这些结果延迟了恢复正常生活质量12，对患者家庭单位造成了心理社会损失13，同时给医疗保健系统带来了沉重的经济负担14。

Even without postoperative complications, up to 40% of patients having major abdominal surgery experience reduced physical function and lower quality of life15,16,17,18. Frailty, sarcopenia, and malnutrition measurably contribute to poor outcomes19,20,21,22. Targeting these risk factors pre-surgery may reduce PPCs and improve overall patient outcomes.In recent years, efforts to improve postoperative outcomes have predominantly focused on intraoperative and postoperative management23,.

即使没有术后并发症，高达40%的腹部大手术患者的身体机能下降，生活质量下降15,16,17,18。虚弱，肌肉减少和营养不良可测量地导致不良结果19,20,21,22。术前针对这些风险因素可能会减少PPC并改善整体患者预后。近年来，改善术后结局的努力主要集中在术中和术后管理23，。

Data availability

数据可用性

All data generated or analyzed during this study are included in this article and its supplementary material files. Further enquiries can be directed to the corresponding author.

本研究期间生成或分析的所有数据均包含在本文及其补充材料文件中。进一步的询问可以直接联系通讯作者。

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History. ERAS® Society. Accessed 12 June 2024. https://erassociety.org/about/history/. (2016).Download referencesFundingFarshad Amirkhosravi is a Burroughs Wellcome Fund Fellow supported by a Burroughs Wellcome Fund Physician Scientist Institutional Award to the Texas A&M University Academy of Physician Scientists.

历史。ERAS®协会。2024年6月12日访问。https://erassociety.org/about/history/.（2016年）。Download referencesFundingFarshad Amirkosravi是Burroughs Wellcome Fund的研究员，由Burroughs Wellcome Fund医师科学家机构奖授予德克萨斯农工大学医师科学家学会。

This sponsor had no involvement in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.Author informationAuthors and AffiliationsDepartment of Surgery, Houston Methodist, Houston, TX, USAFarshad Amirkhosravi, Kelvin C.

该赞助商没有参与数据的收集，分析和解释；在手稿的撰写中；并决定提交稿件出版。作者信息作者和附属机构休斯顿卫理公会外科，德克萨斯州休斯顿，USAFarshad AMIRKOSRAVI，开尔文C。

Allenson, Linda W. Moore & Atiya DhalaOffice of Faculty and Research Development, Department of Academic Affairs, Houston Methodist, Houston, TX, USAJacob M. KolmanSchool of Medicine, Department of Medical Education, Texas A&M University, College Station, TX, USAMargaret FosterCenter for Health Data Science and Analytics, Houston Methodist, Houston, TX, USAEnshuo HsuWm Michael Barnes ‘64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USAFarzan SasangoharCenter for Critical Care, Houston Methodist, Houston, TX, USAFarzan SasangoharAuthorsFarshad AmirkhosraviView author publicationsYou can also search for this author in.

艾伦森（Allenson），琳达·W·摩尔（Linda W.Moore）和阿提亚·达劳（Atiya Dhalao）德克萨斯州休斯顿卫理公会（Houston Methodist），德克萨斯州休斯顿（Houston），美国雅各布·M·科尔曼医学院（Jacob M.KolmanSchool），德克萨斯州农工大学（Texas A＆M University），医学教育系，德克萨斯州大学城（College Station），美国玛格丽特·福斯特健康数据科学与分析中心，休斯顿卫理公会（Houston Methodist），德克萨斯州休斯顿（USAEnshuo），USAFarzan SASANGORSFARSHAD AMIRKHOSRAVIEW作者出版物您也可以在中搜索此作者。

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PubMed Google ScholarContributionsF.A.: data analysis, manuscript writing and editing; data visualization. K.C.A.: data analysis, manuscript writing and editing. L.W.M.: protocol/project development, manuscript writing and editing. J.M.K.: protocol/project development, manuscript writing and editing.

PubMed谷歌学术贡献。A、；数据可视化。K、 C.A.：数据分析，手稿撰写和编辑。五十、 W.M.：协议/项目开发，手稿撰写和编辑。J、 M.K.：协议/项目开发，手稿撰写和编辑。

M.F.: design, data collection and management, manuscript writing. E.H.: data analysis, manuscript writing. F.S.: Protocol/project development, manuscript editing. A.D.: protocol/project development, data analysis, manuscript writing; supervision and project administration. All authors reviewed and approved of the manuscript.Corresponding authorCorrespondence to.

M、 F：设计，数据收集和管理，手稿撰写。E、 H.：数据分析，手稿写作。F、美国：协议/项目开发，稿件编辑。A、 D.：协议/项目开发，数据分析，手稿撰写；监督和项目管理。所有作者都审查并批准了手稿。对应作者对应。

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Reprints and permissionsAbout this articleCite this articleAmirkhosravi, F., Allenson, K.C., Moore, L.W. et al. Multimodal prehabilitation and postoperative outcomes in upper abdominal surgery: systematic review and meta-analysis.

转载和许可本文引用本文Amirkosravi，F.，Allenson，K.C.，Moore，L.W。等人。上腹部手术的多模式康复和术后结果：系统评价和荟萃分析。

Sci Rep 14, 16012 (2024). https://doi.org/10.1038/s41598-024-66633-6Download citationReceived: 21 June 2023Accepted: 03 July 2024Published: 11 July 2024DOI: https://doi.org/10.1038/s41598-024-66633-6Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1416012（2024）。https://doi.org/10.1038/s41598-024-66633-6Download引文接收日期：2023年6月21日接收日期：2024年7月3日发布日期：2024年7月11日OI：https://doi.org/10.1038/s41598-024-66633-6Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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