Effect of irrigation solution temperature on complications of percutaneous nephrolithotomy: a systematic review of the literature, meta-analysis and trial sequential analysis of randomized clinical trials.

IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Minerva Urology and Nephrology Pub Date : 2024-10-01 Epub Date: 2024-05-31 DOI:10.23736/S2724-6051.24.05731-8
Henrique L Lepine, Fernanda M Llata, Breno C Porto, Nathalie C Hobaica, Carlo C Passerotti, Rodrigo A Sanderberg, Everson L Artifon, Jose P Otoch, Jose A da Cruz
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Abstract

Introduction: The optimal temperature of irrigation solution in patients undergoing PCNL is still unclear. Accordingly, this study aims to investigate the effects of different irrigation solution temperatures (cold/room temperature irrigation fluid versus warm/body temperature fluid). Our primary endpoint was hypothermia rate. Secondary outcomes were shivering rate, mean temperature decrease, mean patient final temperature, blood loss, and operative time.

Evidence acquisition: This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were searched in November 2023. Among 299 studies screened, eight were selected for full-text review, resulting in four randomized clinical trials that fit inclusion criteria and desired outcomes. Studies selection and data extraction were performed by multiple reviewers and a random-effects model was used for pooling of data.

Evidence synthesis: The primary outcome, hypothermia rate, showed a significant statistical difference between groups, occurring less frequently in the experimental group (35-37 ºC) than in the cold/room temperature irrigation group (RR 0.64;95%CI 0.46, 0.89; P<0.008; I2=33%). Secondary outcomes such as shivering rate (RR 0.46; 95%CI 0.31, 0.67; P<0.0001; I2=0%) and mean final temperatures (MD 0.43; 95%CI 0.12, 0.75; I2=82%) also showed statistically significant differences between groups, favoring the irrigation with heated fluid.

Conclusions: There was a decreased rate of hypothermia and shivering among patients undergoing PCNL with warm irrigation fluid. Mean final temperatures were also higher in the experimental group. As to blood loss, mean hemoglobin decrease showed no statistically significant difference between groups, prompting further investigation of the influence of Irrigation solution temperature on blood loss volume.

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冲洗液温度对经皮肾镜碎石术并发症的影响:文献系统回顾、荟萃分析和随机临床试验的试验序列分析。
导言:接受 PCNL 手术的患者冲洗液的最佳温度尚不明确。因此,本研究旨在探讨不同冲洗液温度(冷/室温冲洗液与温/体温冲洗液)的影响。我们的主要终点是低体温率。次要结果为颤抖率、平均体温下降率、患者最终平均体温、失血量和手术时间:本系统综述按照 PRISMA 指南进行。2023 年 11 月对多个数据库进行了检索。在筛选出的 299 项研究中,有 8 项被选中进行全文综述,最终有 4 项随机临床试验符合纳入标准和预期结果。研究选择和数据提取由多名审稿人共同完成,并采用随机效应模型对数据进行汇总:主要结果--低体温发生率在组间存在显著统计学差异,实验组(35-37 ºC)的发生率低于低温/室温灌注组(RR 0.64;95%CI 0.46, 0.89; P2=33%)。次要结果如哆嗦率(RR 0.46;95%CI 0.31,0.67;P2=0%)和最终平均温度(MD 0.43;95%CI 0.12,0.75;I2=82%)也显示组间存在显著统计学差异,使用加热液体灌洗更有利:结论:使用温水冲洗 PCNL 的患者体温过低和颤抖的发生率较低。结论:使用温热灌流液进行 PCNL 的患者体温过低和颤抖的发生率较低,实验组的最终平均温度也较高。至于失血量,各组间的平均血红蛋白下降率差异无统计学意义,这促使人们进一步研究灌流液温度对失血量的影响。
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来源期刊
Minerva Urology and Nephrology
Minerva Urology and Nephrology UROLOGY & NEPHROLOGY-
CiteScore
8.50
自引率
32.70%
发文量
237
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