中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

非小细胞肺癌合并慢性阻塞性肺疾病患者围手术期综合管理有效性及安全性的系统评价及 Meta 分析

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目的 系统评价围手术期综合管理措施对非小细胞肺癌(non-small cell lung cancer,NSCLC)合并慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的有效应及安全性。 方法 计算机检索 PubMed、Embase、The Cochrane Library 数据库,中国生物医学文献数据库、中国知网、万方数据库,纳入所有关于 NSCLC 合并 COPD 的研究。检索时间为数据库建库至 2017 年 11 月 1 日。由 2 位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 和 Stata14 软件进行 Meta 分析。 结果 共纳入 20 个研究 1 049 例 NSCLC 合并 COPD 患者,meta 分析结果表明:在肺功能方面,围手术期综合管理可改善患者第一秒用力呼气量(FEV1)、用力肺活量(FVC)、最大自主通气量(MVV)、预计术后一秒率(ppoFEV1%)、肺一氧化碳弥量(DLCO)和第一秒用力呼气率(FEV1%),且差异有统计学意义[分别为:MD=–0.47,95%CI(–0.62,–0.32),P<0.000 1;MD=–0.17,95%CI(0.22,–0.11),P<0.000 1;MD=–4.24,95%CI(–5.37,–3.1),P<0.000 1;MD=–7.54,95%CI(–8.33,–6.76),P<0.000 1;MD=–1.33,95%CI(–2.16,–0.5),P=0.002;MD=–6.93,95%CI(–9.45,–4.41),P<0.000 1],但一氧化碳弥散率(DLCO%)和最大负荷量通气(VEmax)方面差异无统学意义[(MD=–2.91,95%C(–11.31,5.50),P=0.5;MD=0.18,95%CI(–2.23,2.58),P=0.89];在心功能方面,综合管理可改善患者最大摄氧量(VO2max)、6 分钟步行距离(6MWD)和无氧阈值(AT),且差异有统计学意义[MD=–2.28,95%CI(–3.41,–1.15),P<0.000 1,MD=–57.77,95%CI(–77.90,–37.64),P<0.000 1;MD=–2.71,95%CI(–3.30,–2.12),P<0.000 1);和常规治疗相比,综合治疗可明显减少术后肺部短期并发症明显缩短住院时间[OR= 0.39,95%CI(0.26,0.582),P<0.000 1;MD=–1.99,95%C(–2.85,–1.12),P<0.000 1]。 结论 围手术期综合管理可明显改善 NSCLC 合并 COPD 患者的肺功能,减少术后肺部短期并发症,缩短住院时间,具有良好的有效性及安全性。

Objective To evaluate the efficacy and safety of perioperative comprehensive management in non-small cell lung cancer (NSCLC) with chronic obstructive pulmonary disease (COPD). Methods Clinical studies about effect of different perioperative comprehensive management in patients with early NSCLC accompanied with COPD were searched from PubMed, EMbase, The Cochrane Library, CBM and CNKI databases from inception to November 1st, 2017, two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was conducted by RevMan 5.3 and Stata14 software. Results A total of 20 articles were identified. The results of meta-analysis showed that perioperative comprehensive management can improve the forced vital capacity (FVC), maximum minute ventilation (MVV), predictive value of post one-second rate (PpoFEV1%), carbon monoxide diffusing capacity (DLCO) and one-second rate (FEV1%) (MD=–0.47, 95%CI –0.62 to –0.32, P<0.000 1;MD=–0.17, 95%CI –0.22 to –0.11, P<0.000 1;MD=–4.24, 95%CI –5.37 to –3.1, P<0.000 1;MD=–7.54, 95%CI –8.33 to –6.76, P<0.000 1;MD=–1.33, 95%CI –2.16 to –0.5, P=0.002; MD=–6.93, 95%CI –9.45 to –4.41, P<0.000 1, respectively). However, there was no significant difference in the rate of DLCO (DLCO%) and ventilation at maximal workload (VEmax) (MD=–2.91, 95%CI –11.31 to 5.50, P=0.5; MD= 0.18, 95%CI –2.23 to 2.58, P=0.89, respectively). With regard to cardiac function, perioperative comprehensive management can improve the maximal oxygen consumption (VO2max), 6-minute walk distance (6MWD) and anaerobic threshold (AT) (MD=–2.28, 95%CI –3.41 to –1.15, P<0.000 1,MD=–57.77, 95%CI –77.90 to –37.64, P<0.000 1;MD=–2.71, 95%CI –3.30 to –2.12, P<0.000 1, respectively). As to complications, Compared with conventional treatment group, perioperative comprehensive management group had lower postoperative short-term complications (OR=0.39, 95%CI 0.26 to 0.582, P<0.000 1). Besides, perioperative comprehensive management group can also shorten hospitalization time (MD=–1.99, 95%CI –2.85 to –1.12, P<0.000 1). Conclusion Perioperative comprehensive management can significantly improve lung function in patients NSCLC with COPD, reduce short-term postoperative pulmonary complications and shorten the hospital stay, with good effectiveness and safety.

关键词: 非小细胞肺癌; 慢性阻塞性肺疾病; 围手术期; 可视化; Meta 分析

Key words: Non small cell lung cancer; chronic obstructive pulmonary disease; perioperative period; visualization; meta-analysis

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