等体温膀胱冲洗对经尿道前列腺电切术患者干预效果的meta分析

doi:10.19723/j.issn.1671-167X.2023.04.018

摘要/Abstract

摘要：

目的: 评价等体温膀胱冲洗对经尿道前列腺电切术患者的膀胱痉挛、术后出血、生命体征及寒颤不适的影响。方法: 计算机检索Cochrane Library、PubMed、Embase、中国知网(China National Knowledge Infrastructure，CNKI)、万方数据知识服务平台、维普中文期刊服务平台、中国生物医学文献数据库(CBM)有关经尿道前列腺电切术后患者等体温膀胱冲洗的随机对照试验，根据纳入和排除标准筛选文献、提取资料并评价文献质量，采用Revman 5.3软件分析。结果: 共纳入13篇文献，包括2 033例患者。meta分析结果显示，等体温组的膀胱痉挛发生率[相对危险度(risk ratio，RR)=0.51，95%可信区间(95% confidence interval，95%CI)(0.45，0.57)，P＜0.001]及严重程度[均数差(mean difference，MD)=-1.61，95%CI(-2.00，-1.23)，P＜0.001]、导尿管堵塞发生率[RR=0.29，95%CI(0.19，0.44)，P＜0.001]、膀胱冲洗液用量[MD=-6.75，95%CI(-7.33，-6.17)，P＜0.001]和冲洗时间[MD=-7.60，95%CI(-11.91，-3.29)，P < 0.001]、心率[MD=-13.68，95%CI(-15.19，-12.17)，P＜0.001]、收缩压[MD=-29.26，95%CI(-31.92，-26.59)，P＜0.001]、舒张压[MD=-29.36，95%CI(-31.75，-26.98)，P＜0.001]、寒颤不适发生率[MD=0.37，95%CI(0.31，0.44)，P＜0.001]，与室温组相比差异均有统计学意义。结论: 等体温膀胱冲洗可以降低膀胱痉挛及术后导尿管堵塞的发生率，减轻膀胱痉挛，减少冲洗液用量及冲洗时间，增加舒适度。

关键词: 膀胱, 灌洗疗法, 温度, 经尿道前列腺切除术, 手术后并发症

Abstract:

Objective: To evaluate the effect of equal temperature bladder irrigation on bladder spasm, postoperative bleeding, vital signs and discomfort of chills in patients of transurethral resection of prostate using meta-analysis. Methods: Several electronic databases included Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, China Biology Medicine (CBM) were searched systematically for published randomized controlled trial about equal temperature bladder irrigation in patients with transurethral resection of prostate before November 20, 2019. Two reviewers selected independently the literature in the light of the inclusion and exclusion criteria, assessed the risk of bias by quality assessment and extracted data which were consisted of clinical efficacy indexes, such as incidence of bladder spasm, severity of bladder spasm, incidence of tube plugging, amount of bladder flushing fluid, time of bladder flushing, heart rate, systolic pressure, diastolic pressure, and incidence of chills. Data were pooled using fixed-effects model or random-effects model, and the summary effect measure was calculated by risk ratio (RR) or mean difference (MD) and 95% confidence interval (95%CI). Meta-analysis was performed by Review Manager 5.3 Software. Results: In the study, 13 randomized controlled trails met the requirement with a total of 2 033 patients of transurethral resection of prostate were included, of whom 1 015 were carried out with equal temperature bladder irrigation and 1 018 with room temperature bladder irrigation. The results of meta-analysis showed that incidence of bladder spasm [RR=0.51, 95%CI (0.45, 0.57), P < 0.001], severity of bladder spasm [MD=-1.61, 95%CI (-2.00, -1.23), P < 0.001], incidence of urinary blockage [RR=0.29, 95%CI (0.19, 0.44), P < 0.001], dosage of bladder irrigation [MD=-6.75, 95%CI (-7.33, -6.17), P < 0.001], time of bladder rinse [MD=-7.60, 95%CI (-11.91, -3.29), P < 0.001], heart rate [MD=-13.68, 95%CI (-15.19, -12.17), P < 0.001], systolic pressure [MD=-29.26, 95%CI (-31.92, -26.59), P < 0.001], diastolic pressure [MD=-29.36, 95%CI (-31.75, -26.98), P < 0.001], incidence of chills and discomfort [MD=0.37, 95%CI (0.31, 0.44), P < 0.001] in equal temperature group of the patients with transurethral resection of prostate had significantly statistical difference compared with room temperature group. Conclusion: Based on current available evidence, equal temperature bladder irrigation reduced the incidence of bladder spasm and urinary blockage, relieved bladder spasm, reduced dosage and time of bladder irrigation, and hardly affected normal vital signs and increased the patient' s comfort.

Key words: Urinary bladder, Therapeutic irrigation, Temperature, Transurethral resection of prostate, Postoperative complications

中图分类号:

R697.32

许素环,王蓓蓓,庞秋颖,钟丽君,丁炎明,黄燕波,车新艳. 等体温膀胱冲洗对经尿道前列腺电切术患者干预效果的meta分析[J]. 北京大学学报（医学版）, 2023, 55(4): 676-683.

Su-huan XU,Bei-bei WANG,Qiu-ying PANG,Li-jun ZHONG,Yan-ming DING,Yan-bo HUANG,Xin-yan CHE. Effect of equal temperature bladder irrigation in patients with transurethral resection of prostate: A meta-analysis[J]. Journal of Peking University (Health Sciences), 2023, 55(4): 676-683.

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Research	Publishing year	Sample size (ETBIS/ RTBIS)	Bladder rinse temperature/℃		Outcome
Research	Publishing year	Sample size (ETBIS/ RTBIS)	ETBIS	RTBIS	Outcome
Ao et al^[14]	2014	39/39	36-37	25-29	①②④⑤
Chen et al^[9]	2018	130/130	35-37	21-27	①②③④⑤⑥⑦⑧
Cheng et al^[15]	2017	46/46	35-37	21-27	①③
Ding et al^[16]	2016	15/15	37	25	①⑥⑦⑧
Huang et al^[17]	2015	50/50	Near 37	Near 25	①⑥⑦⑧⑨
Li et al^[18]	2010	150/150	< 37	20.2-25.3 (mean 22.1)	①②④⑤⑨
Liu et al^[10]	2019	112/112	35-37	22-25	①⑤
Wang^[12]	2014	45/49	35-37	25-29	①②③④⑤
Wang^[19]	2017	48/47	Near 37	Near 25	①③④⑤
Wen et al^[20]	2016	64/64	35	Indoor temperature	①
Wu et al^[21]	2013	75/75	35-37	25	①②④
Yang^[22]	2019	41/41	35-37	21-27	①②③④⑤
Yang et al^[11]	2013	200/200	Axillary temperature (≤37)	20.2-25.3	①②④⑤⑨