術前常規檢查與選擇性檢查對白內障手術安全性的系統評價_《中國循證醫學雜志》

作者：

艾克萊穆艾爾肯 ¹ ,  具爾提哈地爾 ¹ , 米娜瓦爾阿不都 ¹ , 吳泰相 ² , 簡妮婭 ³

1. 新疆醫科大學第一附屬醫院眼科（烏魯木齊 830054）；2. 四川大學華西醫院中國循證醫學中心（成都 610041）；3. 新疆醫科大學第一臨床學院（烏魯木齊 830054）;

關鍵詞：

白內障術前檢查安全性隨機對照試驗

DOI：

10.7507/1672-2531.20090087

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目的　系統評價術前常規檢查與選擇性檢查對白內障手術的安全性。
方法　按Cochrane 系統評價方法，計算機檢索MEDLINE（1966 ～ 2008.10）、EMbase（1980 ～ 2008.10）、Cochrane 協作網眼和視力組數據庫（2008年3 期）、中國生物醫學文獻數據庫（1979 ～ 2008.10），手工檢索相關會議文獻，納入所有比較術前常規檢查與選擇性檢查對白內障手術安全性的隨機對照試驗，并采用RevMan 5.0 軟件進行Meta 分析。
結果　共納入4 個隨機對照試驗，包括20 490 例患者。Meta 分析結果顯示，白內障手術患者，術前常規檢查與選擇性檢查在術中全身并發癥發生率［RR=1.05，95%CI（0.89，1.24），P=0.59］、術后全身并發癥發生率［RR=0.97，95%CI（0.80，1.18），P=0.77］、術中眼部并發癥發生率［RR=0.99，95%CI（0.74，1.33），P=0.97］及術后眼部并發癥發生率［RR=1.11，95%CI（0.76，1.60），P=0.59］4 方面，其差異均無統計學意義。
結論　術前常規檢查與選擇性檢查相比，白內障手術患者術中、術后全身并發癥發生率，以及術中、術后眼部并發癥發生率差異均無統計學意義，但此結論對于危重病人的適用性有待于進一步研究。因本系統評價納入研究較少，上述結論有待更多設計嚴謹的大樣本隨機對照試驗加以驗證。

引用本文： 艾克萊穆艾爾肯,具爾提哈地爾,米娜瓦爾阿不都,吳泰相,簡妮婭. 術前常規檢查與選擇性檢查對白內障手術安全性的系統評價. 中國循證醫學雜志, 2009, 09(4): 476-480. doi: 10.7507/1672-2531.20090087 復制

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15.	Narr BJ, Hansen TR, Warner MA. Preoperative laboratory screening in healthy Mayo patients: cost-effective elimination of tests and unchanged outcomes. Mayo Clin Proc, 1991, 66: 155-159.
16.	Pasternak LR. Screening patients: strategies and studies. In: McGoldrick KE, ed. Ambulatory anesthesiology: a problem-oriented approach. Baltimore: Williams & Wilkins, 1995: 2-19.
17.	Roizen MF, Kaplan EB, Schreider BD, et al. The relative roles of the history and physical examination, and laboratory testing in preoperative evaluation for outpatient surgery: the “Starling” curve of preoperative laboratory testing. Anesthesiol Clin North Am, 1987, 5: 15.
18.	Velanovich V. Preoperative laboratory evaluation. J Am Coll Surg, 1996, 183: 79-87.
19.	Marcello PW, Roberts PL. “Routine” preoperative studies: which studies in which patients? Surg Clin North Am, 1996, 76: 11-23.
20.	Kaplan EB, Sheiner LB, Boeckmann AJ, et al. The usefulness of preoperative laboratory screening. JAMA, 1985, 253: 3576-3581.
21.	Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the qual ity of reports of parallel-group randomized trials. The CONSORT statement: revised recommendations for improving the quality of reports of parallelgroup randomized trials. Lancet, 2001, 357: 1191-1194.

1. Davison M, Padroni S. Sub-Tenon’s anaesthesia versus topical anaesthesia for cataract surgery. Cochrane Database of Systematic Reviews, 18 July 2007 in Issue 3, 2007.
2. Alhassan MB, Kyari F. Peribulbar versus retrobulbar anaesthesia for cataract surgery. Cochrane Database of Systematic Reviews, 16 July 2008 in Issue 3, 2008.
3. Foster A. Cataract - a global perspective: output, outcome and outlay. Eye, 1999, 13: 449-453.
4. Fletcher A, Vijaykumar V, Selvaraj S, et al. The Madurai Intraocular Lens Study. III: Visual functioning and quality of life outcomes. Am Ophthalmol, 1998, 125(1): 26-35.
5. Riaz Y, Mehta JS, Wormald R, et al. Surgical interventions for agerelated cataract. Cochrane Database of Systematic Reviews, 2002, Issue 2.
6. Lira RP, Nascimento MA, Moreira-Filho DC, et al. Are routine preoperative medical tests needed with cataract surgery? Pan American Journal of Public Health, 2001, 10(1): 13-17.
7. Foster A. Vision 2020: The cataract challenge. Community Eye Health Journal, 2007, 13(34): 17-19.
8. Nascimento MA, Lira RP, Soares PH, et al. Are routine preoperative medical tests needed with cataract surgery? Study of visual acuity outcome. Curr Eye Res, 2004, 28(4): 285-290.
9. Cavallini GM, Saccarola P, D’Amico R, et al. Impact of preoperative testing on ophthalmologic and systemic outcomes in cataract surgery. Euro J Ophthalmol, 2004, 14(5): 369-374.10 Schein OD, Katz J, Bass EB, et al. The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery. N Engl J Medi, 2000, 342(3): 168-175.
10. Higgins JPT, Green S, editors. Assessing risk of bias in included studies . Cochrane Handbook for Sys temat ic Reviews of Interventions 5.0.0 [updated February 2008; Part 2 Chapter 8. In: The Cochrane Library, Issue 3, 2008. Chichester, UK: John Wiley & Sons, Ltd.
11. 吳泰相, 劉關鍵. 隱蔽分組(分配隱藏)和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
12. Roizen MF. More preoperative assessment by physicians and less by laboratory tests. N Engl J Med, 2000, 342: 204-205.
13. American Society of Anestheiologists. New classification of physical status. Anesthesiology, 1963, 24: 111.
14. Roizen MF. Preoperative evaluation. In: Miller RD, ed. Anesthesia.4th ed. Vol. 1. New York: Churchill Livingstone, 1994: 827-82.
15. Narr BJ, Hansen TR, Warner MA. Preoperative laboratory screening in healthy Mayo patients: cost-effective elimination of tests and unchanged outcomes. Mayo Clin Proc, 1991, 66: 155-159.
16. Pasternak LR. Screening patients: strategies and studies. In: McGoldrick KE, ed. Ambulatory anesthesiology: a problem-oriented approach. Baltimore: Williams & Wilkins, 1995: 2-19.
17. Roizen MF, Kaplan EB, Schreider BD, et al. The relative roles of the history and physical examination, and laboratory testing in preoperative evaluation for outpatient surgery: the “Starling” curve of preoperative laboratory testing. Anesthesiol Clin North Am, 1987, 5: 15.
18. Velanovich V. Preoperative laboratory evaluation. J Am Coll Surg, 1996, 183: 79-87.
19. Marcello PW, Roberts PL. “Routine” preoperative studies: which studies in which patients? Surg Clin North Am, 1996, 76: 11-23.
20. Kaplan EB, Sheiner LB, Boeckmann AJ, et al. The usefulness of preoperative laboratory screening. JAMA, 1985, 253: 3576-3581.
21. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the qual ity of reports of parallel-group randomized trials. The CONSORT statement: revised recommendations for improving the quality of reports of parallelgroup randomized trials. Lancet, 2001, 357: 1191-1194.

《中國循證醫學雜志》

術前常規檢查與選擇性檢查對白內障手術安全性的系統評價

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《中國循證醫學雜志》

術前常規檢查與選擇性檢查對白內障手術安全性的系統評價

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