临床护理路径在冠心病PCI术后患者中应用效果的Meta分析

Efficiency of clinical nursing pathway in patients with coronary heart disease after PCI surgery： a meta-analysis

目的 通过Meta分析的方法探讨临床护理路径对冠心病PCI患者术后护理效果的影响.方法 系统检索CNKI、万方、VIP等数据库,检索日期为各库自建库日至2016年8月1日.收集临床护理路径与常规护理对冠心病PCI术后患者影响的随机对照试验（RCT）.两人独立提取资料,采用RevMan 5.2.0软件进行资料分析.结局的效应指标为相对危险度（RR）和均数差（MD）以95%可信区间表示.结果 本研究共纳入19篇文献,2420例冠心病PCI术后患者.纳入文献的方法学质量偏低,普遍为高风险偏倚.Meta分析结果显示：与常规护理组相比,临床护理路径组降低并发症发生率[RR=0.42,95%CI（0.35-0.50）,I2=0%],提高患者满意率[RR=1.14,95%CI（1.11-1.18）,I2=13%],缩短住院时间[MD=-2.67,95%CI（-3.24--2.10）,I2=94%],节省住院费用[MD=-0.44,95%CI（-0.55--0.34）,I2=100%].结论 应用临床护理路径能有效地降低冠心病PCI术后患者并发症的发生率,提高患者的满意度,减少住院时间和住院费用,但是还需设计严谨、实施严格的随机对照试验进一步验证其疗效.

Objective To evaluate the effects of clinical nursing pathway （CNP） on nursing effect of patients with coronary heart disease （CHD） after PCI surgery by meta-analysis.Methods Randomized controlled trials （RCTs） of clinical nursing pathway （CNP） and common nursing for patients with CHD after PIC surgery were searched in several databases including CNKI,Wanfang,and VIP,from the inception of database to August 1st 2016. Two researchers collected papers separately,and applied RevMan 5.2.0 to analyze data. Relative risk （RR）,mean difference （MD）,and 95% confidence intervals （CI） gave evidences to the outcomes. Results Totally 19 researches and 2420 patients with CHD were included in this study. The quality of methodology in those studies was low and high risk of bias was a common limitation. Meta analysis showed that,compared with common nursing group,the incidence rate of complications in clinical nursing pathway group was lower [RR=0.42,95%CI （0.35~0.50）,I2=0%],satisfaction level was higher [RR=1.14,95%CI （1.11~1.18）,I2=13%],hospitalization duration was shorter [MD=-2.67,95%CI （-3.24^-2.10）,I2=94%], and hospitalization cost was lower [MD=-0.44,95%CI （-0.55--0.34）,I2=100%].Conclusions Clinical nursing pathway is effective in lowering incidence rate of complications,increasing patient＇s satisfaction level, shortening hospitalization duration,and cutting hospitalization cost. However,the results need more high-quality,and rigorous-designed RCTs to support.