临床路径在儿童肺炎中应用效果的Meta分析

Application effect of clinical pathways in children pneumonia patients:a meta-analysis

目的从循证医学的角度系统评价临床路径(CP)在儿童肺炎中的应用效果。方法计算机检索中国数字医院图书馆全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、中国生物学文献数据库(CBMdisc)、万方数据库以及追溯研究中的参考文献检索关于临床路径和传统治疗流程在中国儿童肺炎中应用效果的随机对照试验,严格按照纳入与排除标准逐步筛选文献并提取文献中的数据,采用RevMan5.0软件进行系统评价。结果共纳入17项随机对照试验(RCT)研究,总样本量2 717例,临床路径组1 359例,传统治疗流程组1 358例。Meta分析显示临床路径组与传统治疗流程组在健康知识掌握[RR=1.30,95%CI(1.17～1.44),P<0.01]、患者满意度[RR=1.17,95%CI(1.13～1.21),P<0.01]、住院天数[WMD=-2.90,95%CI(-3.93～-1.86),P<0.01]、住院费用[WMD=-620.02,95%CI(-838.99～-401.04),P<0.01]、体温恢复正常时间[WMD=-1.67,95%CI(-2.10～-1.23),P<0.01]、肺部啰音消失时间[WMD=-1.80,95%CI(-2.15～-1.45),P<0.01]方面差异均有统计学意义。结论临床路径在儿童肺炎的应用效果明显优于传统治疗流程,值得在临床推广。

Objective To systematically evaluate the application effect of clinical pathways in children pneumonia patients by using the system analysis.Methods Published RCT in children pneumonia patients were searched and screened in CNKI,VIP,CBMdisc and Wanfang datebase under present standards.The quality of the included studies were evaluated and statistical analyzed by RevMan5.0software.Results Total 17literatures including 2 717cases were eligible to the criteria（1 359in clinical pathways group and 1 358in control group）altogether.The system analysis showed there were significant difference between the clinical pathway group and the traditional treatment group in grasp of health knowledge[RR=1.30,95%CI（1.17-1.44）,P0.01],rate of patients,satisfaction[RR=1.17,95%CI（1.13-1.21）,P0.01],length of hospital stay[WMD=-2.90,95%CI（-3.93-1.86）,P0.01],hospitalization expenses[WMD=-620.02,95%CI（-838.99--401.04）,P0.01],the body temperature to restore normal time[WMD=-1.67,95%CI（-2.10--1.23）,P0.01],lung sound disappear time[WMD=-1.80,95%CI（2.15--1.45）,P0.01].Conclusion Clinical pathways is superior compared with the traditional treatment for children pneumonia patients,be worthy of spread in clinical.