【摘要】：目的:采用Meta分析對胃十二指腸術(shù)后胃癱綜合征(Postoperative gastroparesis syndrome,PGS)的危險因素及其關(guān)聯(lián)強(qiáng)度進(jìn)行綜合評價,為降低術(shù)后胃癱綜合征的發(fā)生率提供循證依據(jù)。方法:檢索國內(nèi)自2006年6月至2016年6月期間公開發(fā)表的有關(guān)胃癱綜合征危險因素的19篇文獻(xiàn)資料,采用Cochrane協(xié)作網(wǎng)提供的Rev Man5.2分析軟件對所提取資料依次進(jìn)行異質(zhì)性檢驗,根據(jù)其結(jié)果選擇不同的模型對各個危險因素進(jìn)行Meta分析。評價12種危險因素與胃癱綜合征的關(guān)聯(lián)性,采用比值比(OR)及其95%可信區(qū)間(95%CI)來表示。結(jié)果:1.性別:進(jìn)行Meta分析的15篇文獻(xiàn)的合并OR值為0.95,95%CI為0.78~1.15。表明男性患者的PGS發(fā)生率與女性患者的PGS發(fā)生率沒有統(tǒng)計學(xué)意義(P0.05)。2.年齡:進(jìn)行Meta分析的8篇文獻(xiàn)的合并OR值為10.75,95%CI為9.49~12.00,表明患者進(jìn)行手術(shù)時年齡小的PGS發(fā)生率低于年齡大的(P0.05)。3.術(shù)前存在幽門梗阻:進(jìn)行Meta分析的14篇文獻(xiàn)的合并OR值為3.66,95%CI為2.95~4.54,表明術(shù)前不存在幽門梗阻的PGS發(fā)生率低于術(shù)前存在幽門梗阻(P0.05)。4.術(shù)前合并焦慮等精神心理:進(jìn)行Meta分析的9篇文獻(xiàn)的合并OR值為2.93,95%CI為2.25~3.80,表明術(shù)前不具有焦慮的精神心理因素的PGS發(fā)生率低于術(shù)前合并焦慮的精神心理因素(P0.05)。5.手術(shù)吻合方式:進(jìn)行Meta分析的16篇文獻(xiàn)的合并OR值為為0.24,95%CI為0.19~0.30,表明行Billroth II手術(shù)吻合的PGS發(fā)生率高于Billroth I手術(shù)吻合(P0.05)。6.術(shù)后使用鎮(zhèn)痛泵:進(jìn)行Meta分析的11篇文獻(xiàn)的合并OR值為2.47,95%CI為1.94~3.15,表明術(shù)后不使用自控鎮(zhèn)痛泵的PGS發(fā)生率低于術(shù)后使用自控鎮(zhèn)痛泵(P0.05)。7.圍手術(shù)期低蛋白血癥:進(jìn)行Meta分析的9篇文獻(xiàn)的合并OR值為2.61,95%CI為2.00~3.42,表明行術(shù)前白蛋白水平小于30g/L的PGS發(fā)生率高于術(shù)前白蛋白水平≥30g/L患者(P0.05)。8.手術(shù)時機(jī):進(jìn)行Meta分析的8篇文獻(xiàn)的合并OR值為1.86,95%CI為1.33~2.60,表明行急診手術(shù)的PGS發(fā)生率高于非急診手術(shù)(P0.05)。9.手術(shù)時間:進(jìn)行Meta分析的5篇文獻(xiàn)的合并OR值為0.75,95%CI為0.65~0.84,表明手術(shù)時間長的PGS發(fā)生率高于手術(shù)時間短的,(P0.05)。10.手術(shù)中出血量:進(jìn)行Meta分析的6篇文獻(xiàn)的合并OR值為84.39,95%CI為80.83~87.94,表表明術(shù)中出血量多的PGS發(fā)生率高于術(shù)中出血量少的(P0.05)。11.手術(shù)方式:進(jìn)行Meta分析的4篇文獻(xiàn)的合并OR值為0.46,95%CI為0.30~0.73,表明開腹手術(shù)的PGS發(fā)生率高于腹腔鏡手術(shù)(P0.05)。12.術(shù)后高血糖:進(jìn)行Meta分析的5篇文獻(xiàn)的合并OR值為4.13,95%CI為2.72~6.29,表明術(shù)后合并高血糖的PGS發(fā)生率高于術(shù)后不合并高血糖的(P0.05)。結(jié)論:與術(shù)后胃癱綜合征發(fā)生相關(guān)聯(lián)的因素有術(shù)前幽門梗阻、較高的年齡、術(shù)后高血糖、較長的手術(shù)時間、急診手術(shù)、圍手術(shù)期的低蛋白血癥、手術(shù)方式、術(shù)前合并焦慮等精神心理因素、BillrothⅡ式吻合、術(shù)中較多的出血量、術(shù)后使用鎮(zhèn)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 鹵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 鹵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 鹵95 CI 2.95 鹵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 鹵95 and CI was 2.25 鹵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 鹵95 CI 1.94 鹵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 鹵95 and CI was 2.00 鹵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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