使用导管引流护理大便失禁患者效果的Meta分析

Effect of Catheter Drainage on Fecal Incontinence: A Meta-Analysis

目的评价国内外使用导管引流和传统肛周皮肤护理法护理大便失禁患者的效果。方法计算机检索CochraneLibrary、PubMed、EMbase、ISI Web of Knowledge、中国学术期刊全文数据库、万方科技期刊全文数据库、维普中文科技期刊数据库,查找比较导管引流和传统肛周皮肤护理法护理大便失禁患者的随机对照试验(randomized controlled trials,RCTs),对纳入的RCTs进行质量评价,并提取有效数据,采用RevMan 5.0软件进行Meta分析。结果共纳入7个RCTs,合计457例患者。纳入文献的方法学质量:1分1篇,2分5篇,3分1篇。以肛周皮肤损伤的发生率为结局指标的漏斗图提示存在发表偏倚。Meta分析结果显示:使用导管引流护理大便失禁患者相较于传统的肛周皮肤护理方法,可降低肛周皮肤并发症的发生率[RR=0.22,95%CI(0.15,0.32),P<0.01],减少护理时间[WMD=-5.13,95%CI(-8.02,-2.25),P<0.01],降低物力成本[WMD=-33.87,95%CI(-47.17,-20.58),P<0.01],差异有统计学意义。结论本系统评价结果显示:使用导管引流护理大便失禁患者的效果优于常规的肛周皮肤护理方法。但因纳入研究的质量不高,导管引流护理大便失禁患者的效果仍需大样本高质量的随机对照试验进一步验证。

Objective To evaluate different effects of nursing the patient with fecal incontinence by catheter drainage or traditional methods.Methods A comprehensive,systematic bibliographic search of medical literature from databases of Cochrane Library,PubMed,Embase,ISI Web of Knowledge,CNKI,Wanfang Data and VIP was conducted to identify randomized controlled trials（RCTs） related to nursing the patients with fecal incontinence by catheter drainage or traditional methods.The quality of RCTs was assessed and meta-analyses were conducted by RevMan5.0.The following outcomes were assessed： complication incidence of perianal skin,nursing time and the cost of supplies.Results Seven RCTs involving 457 patients were included.The methodological quality of all studies was lower.The funnel plot showed asymmetry,indicating that there was publication bias.The results of meta-analyses showed that there was a significant difference between catheter drainage and traditional methods to nurse the patient with fecal incontinence.The catheter drainage was much better to reduce the complication of perianal skin[RR=0.22,95% CI（0.15,0.32）,P〈0.01],nursing time [WMD=-5.13,95% CI（-8.02,-2.25）,P〈0.01] and the cost of supplies[WMD=-33.87,95% CI（-47.17,-20.58）,P〈0.01].Conclusion For the patient with fecal incontinence,the catheter drainage is better than traditional methods.But because of the low quality of the included trials,it is necessary to be verified in future by large-scale randomized controlled trials of higher quality.