系统评价加速康复外科（ERAS）方案在减重代谢手术患者中的临床应用效果。

系统性地检索中英文数据库，包括JBI循证卫生保健中心数据库、Embase、Cochrane Library、Web of Science、PubMed、中国知网、CINAHL、万方、维普及中国生物医学文献数据库。检索时限从建库至2024年12月25日。由两名接受过系统培训的研究人员，各自独立开展文献筛选与质量评估，并进行数据提取工作，数据处理阶段应用RevMan 5.3软件实施Meta分析，对于二分类变量，采用比值比（OR）作为统计指标，对于连续变量，采用均数差（MD）作为统计指标，均附95%置信区间（CI）。

共纳入16篇研究，涵盖3576例患者。通过Meta分析得出，ERAS方案相较于传统围手术期管理，可显著缩短患者的住院时间[MD=-1.40，95%CI(-1.82，-0.99)，P<0.00001]，降低术后恶心呕吐（PONV）发生率[OR=0.44，95%CI(0.21，0.92)，P=0.03]及减少住院费用[MD=-8061.24，95%CI(-12925.10，-3197.38)，P=0.001]；两组在术后的总体并发症发生率[OR=1.00，95%CI(0.75，1.32)，P=0.98]、30天再入院率[OR=0.87，95%CI(0.60，1.26)，P=0.46]、再手术率[OR=0.73，95%CI(0.34，1.59)，P=0.43]及术后镇痛药物使用[OR=0.47，95%CI(0.21，1.04)，P=0.06]方面不具备显著的统计学意义。

ERAS方案可有效优化减重代谢手术患者的围手术期管理，缩短住院时间，降低术后恶心呕吐发生率及医疗成本，且不增加术后不良事件的风险。其临床获益并非源于单一措施，而是多个核心环节的综合作用。鉴于现有研究的异质性及方法学局限性，建议未来研究应扩大样本规模，纳入更多高质量研究，通过设计严谨、样本量充足的RCT，明确各关键措施的独立贡献与协同效应，进一步验证ERAS方案在减重代谢手术患者中的实际效果。

To systematically evaluate the clinical application effect of enhanced recovery after surgery (ERAS) protocols in patients undergoing bariatric and metabolic surgery.

A systematic search was performed across multiple Chinese and English-language databases, including the Joanna Briggs Institute (JBI) Database of Evidence-Based Healthcare, Embase, the Cochrane Library, Web of Science, PubMed, CNKI, CINAHL, Wanfang Data, VIP Database, and the Chinese Biomedical Literature Database. The search period spanned from the inception of each database through December 25, 2024. Two investigators, both rigorously trained in systematic review methodologies, independently conducted the screening, quality assessment, and data extraction processes. Meta-analyses were conducted using RevMan version 5.3. For dichotomous variables, odds ratios (OR) with 95% confidence intervals (CI) were calculated, whereas continuous variables were summarized using mean differences (MD) with corresponding 95%CI.

A total of 16 studies involving 3,576 patients were included. Meta-analysis results demonstrated that, compared with conventional perioperative management, ERAS protocols significantly reduced length of hospital stay [MD= -1.40, 95%CI (-1.82, -0.99), P<0.00001], decreased the incidence of postoperative nausea and vomiting (PONV) [OR= 0.44, 95%CI (0.21, 0.92), P= 0.03], and lowered hospitalization costs [MD= -8061.24, 95%CI (-12925.10, -3197.38), P= 0.001]. No statistically significant differences were observed between ERAS and conventional care in terms of overall postoperative complications [OR= 1.00, 95%CI (0.75, 1.32), P= 0.98], 30-day readmission rate [OR= 0.87, 95%CI (0.60, 1.26), P= 0.46], reoperation rate [OR= 0.73, 95%CI (0.34, 1.59), P= 0.43], or postoperative analgesic use [OR= 0.47, 95%CI (0.21, 1.04), P= 0.06].

ERAS protocols can effectively optimize perioperative management for bariatric and metabolic surgery patients by shortening hospital stay, reducing PONV incidence, and lowering healthcare costs without increasing the risk of adverse postoperative events. The clinical benefits of ERAS are not derived from a single intervention but from the synergistic effects of multiple core components. Given the heterogeneity and methodological limitations of existing studies, future research should expand sample sizes, include more high-quality trials, and conduct rigorously designed randomized controlled trials to clarify the independent contributions and synergistic effects of individual ERAS elements, thereby further validating the clinical effectiveness of ERAS in bariatric and metabolic surgery.