早期活动在ICU机械通气患者获得性衰弱干预应用效果的Meta分析

Meta-analysis of the intervention effects of early ambulation on acquired weakness in intensive care unit patients with mechanical ventilation

目的系统评价早期活动对ICU患者ICU获得性衰弱(ICU-AW)的干预效果。方法计算机检索The Cochrane library、PubMed、EMBASE、MEDLINE、中国生物医学文献数据库、CNKI及万方数据库中关于早期活动对ICU机械通气患者获得性衰弱的随机对照试验,各库检索时间均为建库至2019年2月10日。经筛选文献,提取资料与评价文献质量后,采用RevMan5.3软件进行Meta分析。结果最终纳入11篇随机对照试验。Meta分析结果显示,ICU-AW发病率RR=0.52,95%CI为(0.41,0.66);肌力(MRC-score)WMD=8.08,95%CI为(6.27,9.81);Barthel指数WMD=18.24,95%CI为(7.27,29.2);机械通气时间WMD=-1.29,95%CI为(-1.96,-0.61);ICU住院时间MD=-1.81,95%CI为(-2.78,-0.84);总住院时间WMD=-3.39,95%CI(-5.91,-0.88)。结论基于现有证据,早期活动可降低ICU-AW的发病率,改善患者的肌力,提高患者的日常生活活动能力,同时也能缩短机械通气时间、ICU住院时间和总的住院时间,值得临床推广应用。

Objective To systematic analyze the intervention effects of early ambulation on ICU acquired weakness(ICU-AW)in ICU patients.Methods The Cochrane Library,PubMed,EMBASE,MEDLINE,CBM,CNKI and Wanfang database were searched via computer for randomized controlled trials on early ambulation to prevent ICU-AW in ICU patients from the data base establishment date to February 10th,2019.After screening literature,extracting data and evaluating the quality of literature,Meta-analysis was carried out with RevMan 5.3 software.Results Finally,11 randomized controlled trials were included.Meta-analysis results showed that the incidence of ICU-AW was RR=0.52,95%CI was(0.41,0.66);muscle strength(MRC-score)WMD=8.08,95%CI was(6.27,9.81);Barthel index WMD=18.24,95%CI was(7.27,29.2);mechanical ventilation time was WMD=-1.29,95%CI was(-1.96,-0.61);ICU hospitalization time was MD=-1.81,95%CI was(-2.78,-0.84);total hospitalization time WMD=-3.39,95%CI(-5.91,-0.88).Conclusions Based on the present evidence,early ambulation can reduce the incidence of ICU-AW,improve the activity of daily life ability of patients,shorten the duration of mechanical ventilation,length of stay in ICU and hospital,which is worthy of clinical application.