经皮肾穿刺活检术患者早期下床活动可行性与安全性的Meta分析

摘要/Abstract

摘要： 目的探讨经皮肾穿刺活检术患者早期下床活动的可行性和安全性。方法计算机检索CNKI、维普、万方、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、Web of Science数据库,检索时限为自建库至2024年4月,纳入经皮肾穿刺活检术后患者早期活动和常规卧床的临床对照试验,进行质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入13篇文献,9篇为随机对照研究,4篇为临床对照研究,共2125例患者。Meta分析结果显示：与患者术后常规卧床相比,早期下床活动可以减少尿潴留的发生率[早期活动：51/368;常规卧床：151/559;RR=0.44,95%CI（0.22,0.91）]、腰背部不适感[早期活动：118/637; 常规卧床：265/941;RR=0.52,95%CI（0.43,0.61）]和睡眠紊乱[早期活动：15/92;常规卧床：41/92;RR=0.37,95%CI（0.22,0.60）]。早期活动对患者肉眼血尿和肾周血肿发生率上并无显著差异,无统计学意义（P>0.05）。结论经皮肾穿刺活检术患者术后早期下床活动不增加肉眼血尿、肾周血肿的发生风险,但可以减少术后尿潴留的发生,增进患者的舒适度。

关键词: 经皮肾穿刺活检术, 早期下床活动, Meta分析

Abstract: Objective To explore the feasibility and safety of early ambulation in patients after the percutaneous renal biopsy. Methods Relevant randomized controlled trials(RCTs)were collected using databases of China National Knowledge Infrastructure(CNKI), VIP, Wanfang Database, CBM, PubMed, Cochrane Library, Emba-se, Web of Science from inception of databases to April 2024. Quality evaluation of the included literature were performed. Data were analyzed with Revman 5.3 software. Results Thirteen studies were recruited, including 9 RCTs and 4 CCTs, and 2125 patients were analyzed. The Meta-analysis showed that compared with bed rest,early ambulation reduced the incidence of uroschesis in patients after the percutaneous renal biopsy[early activity: 51/368; bed rest: 151/559; RR=0.44, 95%CI (0.22, 0.91), the incidence of low back discomfort[early activity: 118/637; bed rest: 265/941; RR=0.52, 95%CI(0.43,0.61)], and the incidence of sleep disorder[early activity: 15/92; bed rest: 41/92; RR=0.37, 95%CI(0.22, 0.60)]. There were no statistically significant difference on gross hematuria and perirenal hematoma in patients after the percutaneous renal biopsy. Conclusion Early ambulation did not increase the incidence of gross hematuria and perirenal hematoma in patients after the percutaneous renal biopsy compared with bed rest. However, it can reduce uroschesis in patients after the percutaneous renal biopsy. Besides, early ambulation would be propitious to increase comfort of patients．

Key words: percutaneous renal biopsy, early Ambulation, meta-analysis

中图分类号:

R692

韩敏, 王明雪, 赵娜, 宋起, 王慧. 经皮肾穿刺活检术患者早期下床活动可行性与安全性的Meta分析[J]. 中华养生保健, 2024, 42(22): 4-7.

HAN Min, WANG Mingxue, ZHAO Na, SONG Qi, WANG Hui. The Feasibility and Safety of Early Ambulation in Patients After the Percutaneous Renal Biopsy:a Meta-analysis[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(22): 4-7.

参考文献

[1] 赵纬昊,张亚妮,李柯,等.超声引导下经皮肾穿刺活检后出血的危险因素[J].首都医科大学学报,2022, 43(5):694-699.
[2] 刘承玄,李凡,欧阳晓琴,等.不同超声引导下经皮肾活检方法的临床应用分析[J].影像研究与医学应用,2021,5(17):17-19.
[3] BANDARI J, FULLER T W, TURNER R M, et al.Renal biopsy for medical renal disease: indications and contraindications[J]. Can J Urol,2016,23(1):8121-8126.
[4] POMBAS B, RODRIGUEZ E, SANCHEZ J, et al.Risk factors associated with major complications after ultrasound-guided percutaneous renal biospsy of native kidneys[J]. Kinney and Blood Pressure Research,2020,45(1):122-130.
[5] 上海市社会医疗机构协会超声医学分会.超声引导下肾疾病经皮穿刺活检术实践指南[J].中华医学超声杂志(电子版),2021,18(11):1023-1043.
[6] 梁俊明,蒋泽波,邓建国,等.超声引导下经皮肾穿刺活检术的并发症及危险因素分析[J].数理医药学杂志,2020,33(3):330-332.
[7] 谭炳超. 超声引导下经皮肾穿刺活检术后出血并发症及原因分析[J].影像研究与医用,2021,5(2):221-222.
[8] 李湘萍,杨文菁,王丽娟,等.早期床上活动对经皮肾脏穿刺组织活检术后患者腰背疼痛的影响[J].中华护理杂志,2006,41(6):516-518.
[9] 赵彩萍,王晓娟.肾穿刺活检术后患者适宜床上活动时间探讨[J].中国实用护理杂志,2007,23(11):26.
[10] 王群,韩庆烽,范敏华,等.缩短肾脏穿刺活检术术后病人卧床时问的可行性探讨[J].中国护理管理,2006,6(2):43-44.
[11] 黄静,马志芳,龚海芬.肾穿刺术后患者下床活动时间的临床研究[J].解放军护理杂志,2002,19(3):27-28.
[12] ALEBIOSUEO, KADIRIS.Percutaneous Renal Biopsyasan Outpatient Procedure[J]. Journal of the National Medica lAssociation,2004,96(9):1215-1219.
[13] JPT H, GREEN S.Cochrane handbook for systematic reviews of interventions version5.1.0[M]. London:the Cochrane Collaboration,2011.
[14] 支冬云,李丽萍,杨红宇,等.缩短肾穿刺术后绝对卧床时间对术后并发症的影响[J].实用临床护理学电子杂志,2018,3(11):34-35.
[15] 何玉蓉. 早期床上活动缓解经皮肾脏穿刺组织活检术后患者腰背疼痛的效果分析[J].医学前沿,2017,23(7):104-105.
[16] 樊晓红,熊重祥.不同卧床时间对肾穿刺术后并发症的影响[J]医学前沿,2013,(2):77-78.
[17] 黄燕林,龙娟凤,林带舅,等.B超引导下肾穿刺活检术后缩短患者卧床时间的探讨[J].广西医学,2009,31(5):651-652.
[18] ISHIKAWA E, SHINSUKE, NOMURA, et al.How long is strict bed rest necessary after renal biopsy[J]. Clinical and experimental nephrology,2009,13(6):594-597.
[19] FRASER I R, FAIRLEY K F.Renal biopsy as an outpatient procedure[J]. American journal of kidney diseases:the official journal of the National Kidney Foundation,1995,25(6):876-878.
[20] 温怡,刁永书,温月,等.肾穿术6小时后下床排尿对患者术后并发症的影响[J].西部医学,2012,24(2):394-395.
[21] 赵铖,陈战瑞,杨桢华.超声引导肾自动活检术后缩短卧床时间的临床意义[J] .广西医学,2004,26(4):500-501.
[22] 谢小华,何永成,朱丹,等.肾穿刺术后病人卧位及卧床时间探讨[J].护理研究,2005,19(8):690-691.
[23] ABDULKARIM, AL MAKDAMA, SAMHAR, et al. Safety of percutaneous renal biopsy as an outpatient procedure in pediatric patients[J]. Annals of Saudi medicine,2006,26(4):303-305.
[24] 冯茜,张兴玉.超声引导下经皮肾穿刺活检术后出血并发症及原因分析[J].影像研究与医学应用,2020,4(15):213-214.
[25] 张小白,罗漫丽.儿童经皮肾穿刺活检术后肾周血肿动态超声监测和护理改进[J].医学理论与实践,2020,33(20):3482-3484.