糖皮质激素对肝切除患者术后应激反应及并发症影响的Meta分析

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【中图分类号】 R977.1+1 【文献标识码】A

【Abstract】Objective To systematically review the effcts of perioperative glucocorticoids in alleviating postoperative stress and complications in patients undergoing hepatic resection. Methods PubMed， Cochrane Library，Webofcience，Embase，inoed，WanFangData，CNKIandIdatabases wereelectronicallarched to collect randomized controlled trials （RCTs） on perioperative glucocorticoids in hepatectomized patients from inception to 30 April 2025.Two researchers independently screened the literature， extracted data，and assessed the risk of bias in the included studies.Meta-analysis was then conducted using RevMan 5.4 software. Results A total of15 RCTs involving 1，332 patients were included.Meta-analysis results indicated that the rate of total complications [RR .=0.73 ， 95%CI （0.62， 0.87）， P<0.001 l，postoperative infections [RR .=0.59 ， 95%CI （0.38， 0.91）， P=0.02 l，and liver failure[RR .=0.66 95%CI （0.45， 0.98）， P=0.04 ] in the glucocorticoids group were lower than control group，inflammatory factors such as C-reactive protein （CRP） [SMD 1=-0.83 ， 95%CI （-1.02，-0.65）， P<0.001 ]，and interleukin-6 （IL-6） [SMD 1=-0.99 ， 95%CI （-1.17， -0.80）， P<0.001 ] in the glucocorticoids group were lower than control group; and liver function indexes such as total bilirubin （TBIL） [SMI ）=-0.59 ， 95% CI （-0.88，-0.29）， P<0.001 ]，andaspartateaminotransferase（AST） [SMD =-0.96 0 95%CI （-1.59 -0.33）， P=0.03 ]，and alanine aminotransferase （ALT） [SMD ⊨ -1.20， 95%CI （-2.16，-0.24）， P=0.01 ] levels in the glucocorticoids group were lower than control group;the length of hospital stay in the glucocorticoids group was shorter than control group [MD=-1.24， 95%CI （-2.43， -0.05）， P=0.04 . Conclusion Perioperative use of glucocorticoids significantly reduces the incidence of overall postoperative complications，infections，andliver failure in hepatectomy patients， decreases the release of inflammatory factors， promotes postoperative liver function recovery，and shortens hospital stay， promote patients' post-operative recovery.

【Keywords】Glucocorticoids; Hepatectomy; Perioperative; Infection; Systematic review; Meta-analysis; Randomized controlled trial

肝切除术（liverresection，LR）是治疗肝胆良、恶性疾病的主要手术方法，尤其在肿瘤治疗中应用广泛。（剩余16252字）