围术期目标导向液体疗法联用α-1肾上腺素能受体激动剂对 术后结局的影响：系统回顾与meta分析
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Eff ects of perioperative goal-directed fluid therapy combined with the application of alpha-1 adrenergic agonists on postoperative outcomes: a systematic review and meta-analysis
背景与目的
已有研究证实⽬标导向液体疗法（GDFT）的作⽤⽐过去认为的更加有限。然⽽，α-1肾上腺素能受体激动剂联合适当液体输注的疗效受到越来越多的关注。本研究旨在系统回顾⽬标导向液体疗法（GDFT）联合应⽤α-1肾上腺素能受体激动剂对⾮⼼脏⼿术后康复的影响。
方 法
本项meta分析收集了GDFT联⽤α-1肾上腺素能受体激动剂在⾮⼼脏⼿术患者中应⽤的随机对照试验（RCT）。术后死亡率和住院时间（LOS）作为主要结果。次要预后指标包括术后并发症发⽣率及术后胃肠功能恢复情况。传统配对meta分析⽤于⽐较液体疗法的效果。根据 Cochrane协作组织的偏倚⻛险评估收集到的RCT质量，并⽤漏⽃图、Egger回归测试和Begg调整秩相关性测试来检测发表偏倚。采⽤RevMan 5.3和
Stata 14.0 软件进⾏分析。
结 果
本项meta分析共收集了32例合格的RCTs。围术期GDFT联合应⽤α-1肾上腺素能受体激动剂可显著降低LOS（P = 0.002; I2 = 69%）和总体并发症发⽣率（P =0.04; I2 = 41%），并使⾸次排⽓时间缩短了6.30h（P < 0.00001; I2 = 91%）、固体⻝物耐受时间缩短了1.69天（P < 0.00001; I2 = 0%），促进了胃肠功能恢复。此外，GDFT联⽤α-1肾上腺素能受体激动剂组短期死亡率并⽆明显降低（P = 0.05; I2 =0%）。
结 论
本项系统回顾证据表明，围术期GDFT联合应⽤α-1肾上腺素能受体激动剂可促进⾮⼼脏⼿术患者术后康复。
原始文献摘要
Feng S,Yang SY, Xiao W,et al.Eff ects of perioperative goaldirected fluid therapy combined with the application of alpha-1
adrenergicagonists on postoperative outcomes: a systematic review and metaanalysis[J].BMC Anesthesiology,2018,18:113-126.
Background: Past studies have demonstrated that goal-directed fluid therapy (GDFT) may be more marginal than previously believed. However, beneficial eff ects of alpha-1 adrenergic agonists combined with appropriate fluid administration is getting more and more attention. This study aimed to systematically review the eff ects of goaldirected fluid therapy (GDFT) combined with the application of alpha-1 adrenergic agonists on postoperative outcomes f ollowing noncardiac surgery.
Methods: This meta-analysis included randomized controlled trials (RCTs) on GDFT combined with the application of alpha-1 adrenergic agonists in patients undergoing noncardiac surgery. The primary outcomes included the postoperative mortality rate and length of hospital stay (LOS). The secondary outcome indexes were the incidence of postoperative complications and recovery of postoperative gastrointestinal (GI) f unction. The traditional pairwise meta-analysis was conducted to compare the eff ect of fluid therapy. The quality of included RCTs was evaluated according to the Cochrane Collaboration s risk-of -bias tool. Also, the publication bias was detected using f unnel plots, Egger s regression test, and Begg s adjusted rank correlation test. The meta-analysis was conducted using the RevMan 5.3 and Stata 14.0 sof tware.
Results: Thirty-two eligible RCTs were included in this meta-analysis.Perioperative GDFT combined with the application of alpha-1 adrenergic agonists was associated with a significant reduction in LOS (P = 0.002; I2 = 69%),and overall complication rates (P = 0.04; I2 = 41%). It f acilitated gastrointestinal f unction recovery, as demonstrated by shortening the time to first flatus by 6.30 h (P < 0.00001; I2 = 91%) and the time to toleration of solid f ood by 1.69 days (P < 0.00001; I2 = 0%). Additionally, there was no significant reduction in short-term mortality in the GDFT combined with alpha-1 adrenergic agonists group (P = 0.05; I2 = 0%).
Conclusion: This systematic review of available evidence suggested that the use of perioperative GDFT combined with alpha-1 adrenergic agonists might f acilitate recovery in patients undergoing noncardiac surgery.
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编辑：余晓旭 审校：王贵龙