ABSTRACT
<p><b>OBJECTIVE</b>To assess whether goal-directed fluid management can prevent gastrointestinal complications in major surgery.</p><p><b>METHODS</b>Electronic databases including Cochrane library(Issue 3,2010), Pubmed, EMbase, Highwire, CBM, and CNKI were searched. The date of search was between January 2000 and December 2010. Randomized controlled trials(RCTs) were indentified studying association of goal-directed therapy (GDT) with gastrointestinal complications. Study selection and meta-analysis were conducted according to the Cochrane Handbook for systematic reviews. Data were extracted from these trials by 3 reviewers independently and analyzed by RevMan 5.0 software.</p><p><b>RESULTS</b>Ten trials involving 775 patients were included. GDT significantly improved oxygen supply(WMD=82.95, 95% CI: 17.43-148.46). GDT reduced postoperative hospital stay(WMD=-2.06, 95% CI: -2.95 - -1.17) and decreased postoperative complication rate after major surgery(RR=0.39, 95% CI: 0.29-0.52).</p><p><b>CONCLUSION</b>Goal-directed fluid management can stabilize cardiac output, augment oxygen supply, and therefore reduce postoperative complications.</p>
Subject(s)
Humans , Abdomen , General Surgery , Fluid Therapy , Methods , Gastrointestinal Diseases , Postoperative Complications , Randomized Controlled Trials as TopicABSTRACT
<p><b>OBJECTIVE</b>To assess the efficacy and safety of gastrectomy abdominal drainage after gastrectomy in gastric cancer patients.</p><p><b>METHODS</b>Cochrane systematic evaluation was used to search through Cochrane library (2007-No.3) of clinical comparative trail, PubMed (1976-2008), Embase (1982-2008), Chinese Biomedical Literature Database (CBM 1979-2008), Chinese Scientific Journal Full-text Database (CSJD 1989-2008) and Chinese Journal Full-text Database (CJFD1994-2008), aided with manual retrieval and other retrievals. The quality of the assessment was independently evaluated and cross-checked by two evaluators. The results of homogeneous studies were analyzed with RevMan4.2.10 software.</p><p><b>RESULTS</b>A total of 47 articles were retrieved. Three randomized controlled trials were involved. A total of 338 patients were studied. Of the 338 patients, 160 were treated with total gastrectomy, 178 subtotal gastrectomy. Among the 338 patients, 167 were treated without abdominal drainage. Above 3 trials did not report blind method and did not describe method of allocation concealment. No significant differences were found in pulmonary complication, wound infection, intra-abdominal abscess, clinical leakage and initiation of soft diet between abdominal drainage group and without abdominal drainage group. Statistical results showed odds ratio (OR)=1.23, 95% CI=0.49-3.07 for pulmonary complication; OR=1.09, 95% CI=0.36-3.29 for wound infection; OR=1.28, 95% CI=0.28-5.8 for intra-abdominal abscess; OR=1.53, 95% CI=0.25-9.42 for anastomotic leakage; OR=1.78, 95% CI=0.37-8.56 for hospital mortality; WMD=0.12, 95% CI=-0.11-0.35 for initiation of soft diet. Besides, significant difference was found in hospital stay (WMD=0.65, 95% CI=0.03-1.26), and abdominal drainage group was longer.</p><p><b>CONCLUSION</b>Abdominal drainage after gastrectomy should not be recommended as a regular treatment for gastric cancer patients.</p>