胃十二指肠术后胃瘫综合征相关危险因素的Meta分析

发布时间：2018-12-26 11:29

【摘要】：目的:采用Meta分析对胃十二指肠术后胃瘫综合征(Postoperative gastroparesis syndrome,PGS)的危险因素及其关联强度进行综合评价,为降低术后胃瘫综合征的发生率提供循证依据。方法:检索国内自2006年6月至2016年6月期间公开发表的有关胃瘫综合征危险因素的19篇文献资料,采用Cochrane协作网提供的Rev Man5.2分析软件对所提取资料依次进行异质性检验,根据其结果选择不同的模型对各个危险因素进行Meta分析。评价12种危险因素与胃瘫综合征的关联性,采用比值比(OR)及其95%可信区间(95%CI)来表示。结果:1.性别:进行Meta分析的15篇文献的合并OR值为0.95,95%CI为0.78~1.15。表明男性患者的PGS发生率与女性患者的PGS发生率没有统计学意义(P0.05)。2.年龄:进行Meta分析的8篇文献的合并OR值为10.75,95%CI为9.49~12.00,表明患者进行手术时年龄小的PGS发生率低于年龄大的(P0.05)。3.术前存在幽门梗阻:进行Meta分析的14篇文献的合并OR值为3.66,95%CI为2.95~4.54,表明术前不存在幽门梗阻的PGS发生率低于术前存在幽门梗阻(P0.05)。4.术前合并焦虑等精神心理:进行Meta分析的9篇文献的合并OR值为2.93,95%CI为2.25~3.80,表明术前不具有焦虑的精神心理因素的PGS发生率低于术前合并焦虑的精神心理因素(P0.05)。5.手术吻合方式:进行Meta分析的16篇文献的合并OR值为为0.24,95%CI为0.19~0.30,表明行Billroth II手术吻合的PGS发生率高于Billroth I手术吻合(P0.05)。6.术后使用镇痛泵:进行Meta分析的11篇文献的合并OR值为2.47,95%CI为1.94~3.15,表明术后不使用自控镇痛泵的PGS发生率低于术后使用自控镇痛泵(P0.05)。7.围手术期低蛋白血症:进行Meta分析的9篇文献的合并OR值为2.61,95%CI为2.00~3.42,表明行术前白蛋白水平小于30g/L的PGS发生率高于术前白蛋白水平≥30g/L患者(P0.05)。8.手术时机:进行Meta分析的8篇文献的合并OR值为1.86,95%CI为1.33~2.60,表明行急诊手术的PGS发生率高于非急诊手术(P0.05)。9.手术时间:进行Meta分析的5篇文献的合并OR值为0.75,95%CI为0.65~0.84,表明手术时间长的PGS发生率高于手术时间短的,(P0.05)。10.手术中出血量:进行Meta分析的6篇文献的合并OR值为84.39,95%CI为80.83~87.94,表表明术中出血量多的PGS发生率高于术中出血量少的(P0.05)。11.手术方式:进行Meta分析的4篇文献的合并OR值为0.46,95%CI为0.30~0.73,表明开腹手术的PGS发生率高于腹腔镜手术(P0.05)。12.术后高血糖:进行Meta分析的5篇文献的合并OR值为4.13,95%CI为2.72~6.29,表明术后合并高血糖的PGS发生率高于术后不合并高血糖的(P0.05)。结论:与术后胃瘫综合征发生相关联的因素有术前幽门梗阻、较高的年龄、术后高血糖、较长的手术时间、急诊手术、围手术期的低蛋白血症、手术方式、术前合并焦虑等精神心理因素、BillrothⅡ式吻合、术中较多的出血量、术后使用镇痛泵。
[Abstract]:Objective: to evaluate the risk factors and associated strength of gastroparesis syndrome (Postoperative gastroparesis syndrome,PGS) after gastroduodenal surgery by Meta analysis, and to provide evidence-based evidence for reducing the incidence of postoperative gastroparesis syndrome. Methods: from June 2006 to June 2016, 19 articles of literature on the risk factors of gastroparesis syndrome were retrieved, and the heterogeneity of the extracted data was examined by Rev Man5.2 software provided by Cochrane Cooperative Network. According to the results, different models were selected to analyze the risk factors by Meta. To evaluate the correlation between 12 risk factors and gastroparesis syndrome, the ratio (OR) and its 95% confidence interval (95%CI) were used. Results: 1. Sex: the combined OR value of 15 articles for Meta analysis was 0.95 卤0.78 CI 0.78 / 1.15. The results showed that the incidence of PGS in male patients was not significantly different from that in female patients (P0.05). Age: the combined OR value of 8 articles of Meta analysis was 10.75 卤9595 CI = 9.491.00, which indicated that the incidence of PGS at the time of operation was lower than that of the older ones (P0.05). Preoperative pyloric obstruction: the combined OR value of 14 articles for Meta analysis was 3.66 卤95 CI 2.95 卤4.54, indicating that the incidence of PGS without pyloric obstruction before operation was lower than that without pyloric obstruction before operation (P0.05). Mental and psychological factors such as anxiety before operation: the combined OR value of 9 articles for Meta analysis was 2.93 卤95 and CI was 2.25 卤3.80, respectively. The results showed that the incidence of PGS without anxiety was lower than that with anxiety before operation (P 0.05). Operative anastomosis: the combined OR value of 16 articles with Meta analysis was 0.2495 CI 0.190.30, which indicated that the incidence of PGS with Billroth II operation anastomosis was higher than that with Billroth I operation anastomosis (P0.05). Postoperative analgesic pump: the combined OR value of 11 articles for Meta analysis was 2.47 卤95 CI 1.94 卤3.15, which indicated that the incidence of PGS without PCAP was lower than that of PCAP (P0.05). Perioperative hypoproteinemia: the combined OR values of 9 articles for Meta analysis were 2.61 卤95 and CI was 2.00 卤3.42, respectively. The incidence of PGS with preoperative albumin level less than 30g/L was higher than that of patients with preoperative albumin level 鈮，

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