目的 采用Meta分析评价术中限制性输液对外科手术患者术后恢复的影响,为围术期输液提供偱证医学依据.方法 检索截至2011年6月Medline、PubMed、Cochrane图书馆、CBM、CNKI、中国生物医学文献数据库中围术期控制性输液与自由输液的随机对照研究(RCT)公开发表文献,收集各研究中的术后并发症、平均住院时间、术后肠功能恢复时间等指标.计数资料采用优势比(OR)和95%可信区间表示,计量资料采用加权平均值(WMD)和95%可信区间表示,所有计算和统计用RevMan4.2.10软件完成.结果 根据文献纳入及排除标准,共有10篇文献包含1 181位病例入选本研究,包括限制容量组589例,自由输液组592例.结果表明,限制容量组术后并发症(OR=0.27,95%CI:0.21,0.36,P < 0.01)、平均住院时间(WMD=-1.19,95%CI:-1.96,-0.41,P < 0.01)、肠功能恢复时间(WMD=-1.19,95%CI:-1.96,-0.41,P < 0.01)均明显优于自由输液组.结论 择期手术术中限制性输液可明显减少术后并发症,使胃肠功能恢复时间和住院时间缩短,有利于患者康复.%Objective To analyze the effects of restrictive transfusion on the outcome of major surgery. Methods Data were obtained by searches of restrictive protocol group (RPG) versus liberal protocol group (LPG) in major adult selective surgery from Medline, PubMed, Cochrane libriary, CNKI and CMBdisk before June 2011. It was undertooked that only randomized controlled trials (RCTs) evaluating the postoperative morbidity and mortality, cardiopulmonary morbidity, wound infection and bowel function recovery during hospital stay. Statistical analysis was performed by RevMan 4.2.10. Heterogeneity was assessed using χ2 and I2 values. Results A total of 1 181 patients in ten trials, there were 589 in RFG and 592 in LFG. It was found that patients in RFG had a lower risk of post-operative complications (OR=0.27, 95%CI: 0.21, 0.36, P < 0.01), a shorter time to first bowel movement (WMD=-1.19, 95%CI: -1.96, -0.41, P < 0.01) and length of hospital stay (WMD=-1.19, 95%CI: -1.96, -0.41, P < 0.01) compared with those in LFG. Conclusion The present meta-analysis suggests that a fluid restriction strategy improves an outcome after major surgery.
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