摘要目的 探讨每搏变异度(SVV)指导的目标导向液体治疗对胃肠道手术患者术后胃肠功能恢复时间和住院时间的影响,从而为其临床应用提供循证医学的证据.方法 检索PubMed、Medline、Google Scholar、Web of Science、中国知网、维普、万方数据库中包含SVV指导的目标导向液体治疗与胃肠道手术患者术后功能恢复相关的研究,检索时间为2008—2017年.试验组采用目标导向液体治疗,对照组采用传统补液治疗.主要分析指标有术后首次排气时间、术后首次排便时间、术后首次进食时间、术后住院时间或总住院时间等.采用RevMan 5.3软件进行Meta分析.结果 共有13篇随机对照研究851例患者纳入分析.8篇文献比较了总住院时间,结果显示差异有统计学意义(MD=-4.12,95% CI-5.93～-2.30,P<0.01);6篇文献比较了术后住院时间,结果显示差异有统计学意义(MD=-2.64,95% CI-3.84~-1.43,P<0.01);12篇文献比较了术后首次排气时间,结果显示差异有统计学意义(MD=-15.32,95% CI-19.96～-10.69,P<0.01);7篇文献比较了两组的术后首次排便时间,结果显示差异有统计学意义(MD=-13.55,95% CI-17.86～-9.24,P<0.01);7篇文献比较了两组的术后首次进食时间,结果显示差异有统计学意义(MD=-13.20,95% CI-17.61～-8.80,P<0.01).结论 SVV指导的目标导向液体治疗方案有助于胃肠道手术患者术后更早地恢复胃肠道功能,缩短住院时间或术后住院时间.

abstractsObjective To explore the influence of goal-directed fluid therapy guided by stroke volume variation (SVV) on the recovery of gastrointestinal function and the length of hospital stay in patients undergoing gastrointestinal surgery, thus provide evidence for clinical application. Methods The studies related to the functional recovery of patients undergoing gastrointestinal surgery, including goal-directed fluid therapy guided by SVV were search in the PubMed, Medline, Google Scholar, Web of Science, CNKI, VIP and Wanfang data from 2008 to 2017. The experiment group was treated with goal-directed fluid therapy, and the control group was treated with open fluid therapy. The key indexes included first time of exhaust time, postoperative first defecation time, postoperative first feeding time, length of postoperative hospital stay or total length of hospital of stay. The Meta-analysis used RevMan 5.3 statistical software. Results A total of 13 randomized controlled trials containing 851 patients was included. The total length of hospitalization was compared in 8 articles, and the results showed that the difference was statistically significant ( MD = -4.12, 95% CI-5.93 to-2.30, P < 0.01). The length of postoperative hospital stay was compared in 6 articles, and the results showed that the difference was statistically significant ( MD=-2.64, 95% CI-3.84 to-1.43, P<0.01). The first time of exhaust time was compared in 12 articles, and the results showed that the difference was statistically significant ( MD=-15.32, 95% CI-19.96 to-10.69, P<0.01). The postoperative first defecation time was compared in 7 articles, and the results showed that the difference was statistically significant ( MD=-13.55, 95% CI-17.86 to -9.24, P < 0.01). The postoperative first feeding time was compared in 7 articles, and the results showed that the difference was statistically significant ( MD=-13.20, 95% CI-17.61 to-8.80, P < 0.01). Conclusions Goal-directed fluid therapy by SVV programs can help patients undergoing gastrointestinal surgery with earlier recovery in gastrointestinal function and shorter length of hospital stay or postoperative hospital stay.