Non-drug perioperative interventions to reduce postoperative pulmonary complications after abdominal surgery: systematic review and meta-analysis.

Methods

Systematic reviewand meta-analysis.

系统评价和荟萃分析。

data_sources

Ovid MEDLINE, Embase, and Web of Science from database inception to January 2025 and updated in January 2026, with no language restrictions.

Ovid MEDLINE、Embase 和 Web of Science 从数据库创建之初至2025年1月，且在2026年1月进行了更新，未设语言限制。

study_selection

Randomised controlled trials assessing the effectiveness of perioperative non-drug interventions for the prevention of PPCs in adults undergoing elective abdominal surgery under general anaesthesia, with clearly defined PPCs.

随机对照试验评估了全身麻醉下择期腹部手术成人的围手术期非药物干预措施预防术后肺部并发症（PPCs）的有效性，其中PPCs有明确的定义。

Methods

The primary outcome was the proportion of patients developing PPCs.

主要结果是发展为围手术期肺部并发症（PPCs）的患者比例。

Secondary outcomes included the proportion of patients with PPC subtypes according to European Perioperative Clinical Outcome definitions (respiratory infection, respiratory failure, pleural effusion, atelectasis, or pneumothorax) and hospital length of stay.

次要结果包括根据欧洲围手术期临床结果定义的PPC亚型患者比例（包括呼吸道感染、呼吸衰竭、胸腔积液、肺不张或气胸）以及住院时长。

data_extraction_and_synthesis

Two reviewers independently screened studies, extracted data, and assessed risk of bias with the Cochrane RoB 2.0 tool.

两位审查员独立筛选研究，提取数据，并使用Cochrane RoB 2.0工具评估偏倚风险。

Data were synthesised using meta-analyses and trial sequential analyses, with the evidence certainty assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

数据通过元分析和试验序列分析进行综合，使用Grading of Recommendations, Assessment, Development and Evaluation (GRADE)方法评估证据的确定性。

Results

255 trials including 55 260 participants were included, evaluating 10 types of interventions with 39 subtypes for PPC prevention.

共纳入255项试验，包括55 260名参与者，评估了10种干预措施及其39个亚型，用于预防术后肺部并发症（PPCs）。

PPCs occurred in 6467 (11.7%) participants across all included trials.

在所有纳入的试验中，有6467名（11.7%）参与者发生了术后肺部并发症（PPCs）。

High certainty evidence showed that low fraction of inspired oxygen (FiO2) significantly reduced PPCs (risk ratio 0.81, 95% confidence interval0.71 to 0.92).

高确定性证据表明，低吸入氧分数（FiO2）显著降低了术后肺部并发症（PPCs）的发生风险（风险比为0.81，95%置信区间为0.71至0.92）。

Moderate certainty evidence showed benefit for four intervention types: lung protective ventilation (risk ratio 0.66, 0.57 to 0.76), physiotherapy (0.55, 0.46 to 0.65), analgesia (0.73, 0.64 to 0.84), and nutrition (0.74, 0.63 to 0.87), with individualised positive end expiratory pressure, composite lung protective ventilation, early mobilisation, and epidural analgesia also showing benefit at the subtype level.

中等确定性证据表明，四种干预措施有益：肺保护性通气（风险比为0.66，95%置信区间为0.57至0.76）、物理治疗（风险比为0.55，95%置信区间为0.46至0.65）、镇痛（风险比为0.73，95%置信区间为0.64至0.84）和营养支持（风险比为0.74，95%置信区间为0.63至0.87），个体化的正压呼气末期压力、综合肺保护性通气、早期活动和硬膜外镇痛在亚组水平上也显示出益处。

Trial sequential analysis confirmed sufficient cumulative evidence for all the above interventions except early mobilisation.

试验序贯分析确认了上述所有干预措施（除了早期活动）累积证据的充分性。

By contrast, goal directed haemodynamic therapy, targeted blood pressure management, restrictive fluid therapy, and postoperative bi-level positive airway pressure showed no evidence of benefit, with moderate certainty.

相比之下，目标导向的血流动力学治疗、靶向血压管理、限制性液体治疗和术后双水平正压通气显示出无益证据，其确定性为中等。

Conclusions

This synthesis establishes an evidence hierarchy for PPC prevention in abdominal surgery.

本综述为腹部手术中预防术后肺部并发症（PPC）建立了证据等级。

Low FiO2 is the only intervention supported by high certainty evidence and should be prioritised in clinical practice.

低浓度氧疗（Low FiO2）是唯一得到高确定性证据支持的干预措施，在临床实践中应优先考虑。

Other beneficial strategies include lung protective ventilation, physiotherapy, analgesic techniques, and nutrition interventions.

其他有益策略包括肺保护性通气、物理治疗、镇痛技术以及营养干预。

Conversely, the role of goal directed haemodynamic therapy-despite its widespread use-warrants reconsideration for PPC prevention.

相反，尽管目标导向的血流动力学治疗广泛使用，但其在预防PPC中的作用需要重新考虑。

These findings facilitate prioritisation of effective interventions and development of evidence based guidelines.

这些发现有助于优先考虑有效的干预措施，并制定基于证据的指南。

study_registration

PROSPERO CRD42025637449.

PROSPERO CRD42025637449。