快速康复外科护理干预甲状腺癌患者围手术期应用效果的Meta分析

Impact of ERAS Nursing Interventions on Perioperative Outcomes in Thyroid Cancer: A Meta-Analysis

摘要: 目的：评价快速康复外科(ERAS)护理干预对甲状腺癌患者围手术期康复效果的影响，为优化临床护理路径提供循证依据。方法：全面检索中国知网(CNKI)、万方(Wanfang)、维普数据库(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Embase及Cochrane Library数据库，时限为建库至2025年3月。检索策略采用主题词与自由词结合，纳入比较ERAS护理干预与常规护理对甲状腺癌患者围术期结局影响的随机对照试验(RCT)。由两名研究者独立筛选文献、提取数据并评估方法学质量(Cochrane ROB工具)。采用RevMan 5.4软件计算相对危险度(RR)或均数差(MD)或标准化均数差(SMD)及其95%置信区间。结果：共纳入46项RCT，涵盖4000例甲状腺癌手术患者。Meta分析显示，ERAS护理干预可显著缩短术后住院时间(MD = −2.58天，95% CI [−2.84, −2.32])、缩短术后首次下床时间(SMD = −2.29, 95% CI [−2.71, −1.87])，降低术后并发症发生率(RR = 0.25, 95% CI [0.20, 0.32])。结论：快速康复外科护理干预可有效促进甲状腺癌患者围手术期康复，降低医疗资源消耗，但需规范ERAS核心措施(如颈部功能锻炼指导、喉返神经监测)以提升干预一致性。由于本研究纳入文献均为中文文献，研究结果可能受到语言偏倚和发表偏倚的影响，其普遍适用性仍需谨慎解读。未来还需开展多中心研究验证其在腔镜手术与复杂甲状腺癌中的适用性。

Abstract: Objective: This paper aims to evaluate the impact of Enhanced Recovery After Surgery (ERAS) nursing interventions on perioperative rehabilitation outcomes in patients with thyroid cancer, thereby providing an evidence-based basis for optimizing clinical nursing pathways. Methods: A comprehensive search was conducted across CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, and Cochrane Library, covering studies published from database inception to March 2025. The search strategy combined subject headings and free-text terms. Randomized controlled trials (RCTs) comparing ERAS nursing interventions with conventional perioperative care for thyroid cancer patients were included. Two researchers independently screened literature, extracted data, and assessed methodological quality using the Cochrane Risk of Bias (ROB) tool. RevMan 5.4 software was employed to calculate relative risk (RR), mean difference (MD), or standardized mean difference (SMD) with 95% confidence intervals (CIs). Results: A total of 46 RCTs were included, encompassing 4000 thyroid cancer surgical patients. Meta-analysis demonstrated that ERAS nursing interventions significantly reduced postoperative hospital stay (MD = −2.58 days, 95% CI [−2.84, −2.32]), shortened time to first ambulation (SMD = −2.29, 95% CI [−2.71, −1.87]), and decreased postoperative complication rates (RR = 0.25, 95% CI [0.20, 0.32]). Conclusion: ERAS nursing improves perioperative recovery and reduces healthcare resource use in thyroid cancer patients, but core measure standardization (e.g., neck exercise guidance and recurrent laryngeal nerve monitoring) is needed for consistency. Since all studies included in this research are Chinese-language literature, the findings may be subject to language bias and publication bias. Therefore, the generalizability of the results should be interpreted with caution. Future multicenter studies should validate its use in endoscopic surgery and complex cases.