本文選題：胃癌 + 圍手術(shù)期處理　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：研究目的:隨著加速康復(fù)外科(ERAS)理念的迅速發(fā)展,使得胃癌患者圍手術(shù)期治療、護(hù)理模式發(fā)生了很大的變化。越來(lái)越多的證據(jù)也已經(jīng)證實(shí),圍手術(shù)期加速康復(fù)外科方案的實(shí)施,能夠有效的降低胃癌患者術(shù)后并發(fā)癥發(fā)生、加快患者術(shù)后康復(fù)。但是,指南中仍有一些存在爭(zhēng)議的圍手術(shù)期處理措施。本研究將會(huì)對(duì)存在爭(zhēng)議的ERAS措施進(jìn)行嚴(yán)格的系統(tǒng)評(píng)價(jià),進(jìn)一步證實(shí)其安全、有效性,并對(duì)每一條方案的證據(jù)質(zhì)量和推薦級(jí)別進(jìn)行論證。最終,形成一套有循證醫(yī)學(xué)證據(jù)支持的,更加優(yōu)化的胃癌患者圍手術(shù)期ERAS臨床路徑。研究方法:我們通過(guò)標(biāo)準(zhǔn)數(shù)據(jù)庫(kù),全面檢索與胃癌患者圍手術(shù)期ERAS方案相關(guān)的臨床研究,尤其是高質(zhì)量的臨床隨機(jī)對(duì)照研究(RCTs)和Meta分析。對(duì)存在爭(zhēng)議的方案,應(yīng)用Rev Man5.3軟件進(jìn)行系統(tǒng)評(píng)價(jià),進(jìn)一步證實(shí)其臨床應(yīng)用的安全、有效性。最后,我們依據(jù)“The Grading of Recommendations,Assessment,Development and Evaluation(GRADE)評(píng)分系統(tǒng),對(duì)每一條措施的循證醫(yī)學(xué)證據(jù)質(zhì)量和推薦級(jí)別進(jìn)行論證。研究結(jié)果:本研究對(duì)胃癌患者ERAS方案中,有爭(zhēng)議的部分進(jìn)行了進(jìn)一步的系統(tǒng)評(píng)價(jià)。Meta分析結(jié)果顯示:(1)術(shù)前口服碳水化合物能夠明顯的降低患者術(shù)后第一天血糖水平、縮短住院時(shí)間,不會(huì)增加患者術(shù)后并發(fā)癥的發(fā)生風(fēng)險(xiǎn);(2)術(shù)后早期經(jīng)口進(jìn)食能夠明顯縮短患者術(shù)后住院時(shí)間,而不增加圍手術(shù)期并發(fā)癥的發(fā)生風(fēng)險(xiǎn);(3)圍手術(shù)期目標(biāo)導(dǎo)向性液體治療(GDFT)可以減少患者術(shù)后并發(fā)癥的發(fā)生風(fēng)險(xiǎn),縮短患者術(shù)后住院時(shí)間。最后,我們根據(jù)GRADE評(píng)分系統(tǒng),對(duì)胃癌患者圍手術(shù)期ERAS每項(xiàng)措施的證據(jù)質(zhì)量和推薦等級(jí)進(jìn)行了論證。并將每條措施的證據(jù)級(jí)別分為高、中等、低和極低,將推薦強(qiáng)度分為強(qiáng)和弱。研究結(jié)論:通過(guò)對(duì)幾項(xiàng)有爭(zhēng)議的方案進(jìn)行Meta分析,結(jié)果證實(shí)術(shù)前口服碳水化合物、術(shù)后早期經(jīng)口進(jìn)食以及圍手術(shù)期有效的液體管理等,都可以安全、有效的應(yīng)用于臨床,加速患者術(shù)后康復(fù)。此外,我們對(duì)ERAS方案中每一條措施進(jìn)行了證據(jù)質(zhì)量和推薦強(qiáng)度的論證,形成一條適用于胃癌患者的ERAS臨床路徑,為胃癌患者圍手術(shù)期處理提供了證據(jù)指南。但是,我們還需要更多高質(zhì)量的、多中心臨床研究,去完善胃癌患者圍手術(shù)期臨床路徑的管理。
[Abstract]:Objective: with the rapid development of the idea of accelerated rehabilitation surgery (ERASS), the nursing mode of gastric cancer patients has changed greatly in perioperative period. More and more evidence has also confirmed that the implementation of perioperative accelerated rehabilitation surgery can effectively reduce postoperative complications in patients with gastric cancer and accelerate postoperative rehabilitation. However, there are still some controversial perioperative procedures in the guidelines. This study will make a strict systematic evaluation of the controversial ERAS measures to further verify their safety and effectiveness, and demonstrate the quality of evidence and the recommended level of each scheme. Finally, a set of more optimized perioperative ERAS clinical pathways for gastric cancer patients supported by evidence-based medical evidence was developed. Methods: we searched the clinical studies related to perioperative ERAS regimen in gastric cancer patients by standard database, especially in high quality randomized controlled clinical trials (RCTs) and Meta analysis. Rev Man5.3 software was used to evaluate the controversial scheme, which confirmed the safety and effectiveness of its clinical application. Finally, we demonstrate the quality of evidence-based medical evidence and the level of recommendation for each measure according to the The Grading of recommendations Development and Evaluation system. Results: in this study, the controversial parts of ERAS regimen in patients with gastric cancer were further systematically evaluated. Meta-analysis results showed that oral carbohydrates before operation significantly decreased blood glucose levels on the first day after operation in patients with gastric cancer. Shortening the hospitalization time and not increasing the risk of postoperative complications. (2) early oral feeding after operation can significantly shorten the postoperative hospitalization time of the patients. The GDFTs can reduce the risk of postoperative complications and shorten the postoperative hospitalization time. Finally, according to the GRADE scoring system, we demonstrated the quality of evidence and the recommended grade of each measure of ERAS in patients with gastric cancer during perioperative period. The evidence levels of each measure are classified as high, medium, low and very low, and the recommended strength is divided into strong and weak. Conclusion: through Meta analysis of several controversial protocols, the results show that oral carbohydrates preoperatively, early oral feeding after surgery and effective fluid management during perioperative period can be safely and effectively applied in clinical practice. Accelerate the patient's postoperative recovery. In addition, we have demonstrated the quality of evidence and the recommended strength of each measure in the ERAS scheme, and formed a ERAS clinical path suitable for gastric cancer patients, which provides evidence guidance for the perioperative management of gastric cancer patients. However, we need more high-quality, multi-center clinical studies to improve the management of perioperative clinical pathways in patients with gastric cancer.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2

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