约束对留置管道患者预防非计划性拔管效果的系统评价

Systematic Review of Physical Restraint in Preventing Unplanned Extubation

目的采用系统评价的方法就约束对留置管道患者预防非计划性拔管的效果进行研究,以期为护理实践提供依据。方法计算机检索PubMed、Ovid、Cochrane图书馆、EMBASE、CBM、CNKI等数据库,手工检索相关的中文护理杂志并追踪纳入文献的参考文献,按照纳入和排除标准获取有关约束对非计划性拔管影响的所有随机对照试验和临床对照试验,质量评价后综合应用定性和定量方法对提取的数据进行分析。结果共纳入8篇文献,数据分析后显示:(1)约束组意外拔管率高于无约束组(OR:2.84,95%CI:1.91～4.24);(2)对约束者加强护理干预组意外拔管率低于单纯约束组(OR:0.2,95%CI:0.11～0.36),前者并发症发生率低于后者(OR:0.19,95%CI:0.1～0.38)。结论单纯约束对预防非计划性拔管的效果不明显,有时反而成为增加其发生的因素之一,但对约束患者加强护理干预后则效果优于单纯约束。鉴于目前国内外有关此项的研究质量不高,今后仍需要高质量的、设计严谨的临床试验来验证约束对非计划性拔管的影响。

Objective To systematically review the physical restraint in preventing unplanned extubation-and provide basis for nursing practice.Methods PubMed,Ovid,Cochrane Library,EMBASE,CBM,CNKIdatabase were searched through computer retrieval,and manual searched in relevant Chinese nursing jour-nals,tracing references from determined literatures.All information concerning the RCTs, qRCTs and non-RCTs were acquired.After assessing the study quality,a qualitative evaluation and meta-analysis were usedto analysis the data. Results 8 studies were acquired, after the data analyses, it results showed （1） theunplanned extubation rate of the physical restraint group was higher than that of the unrestraint group（0R：2.84,95% CI：1.91--4.24）;（2）the unplanned extubation rate of the intervention group was lowerthan that of the control group（OR ：0.2,95 CI：O. 11--0.36）, and the occurrence of complications in the in-tervention group was lower than that of the control group （OR ： O. 19,95 % CI ： 0.1 -- 0.38）. ConclusionPhysical restraint was not effective on prevention of unplanned extubation, sometimes it even increased theoccurrence on the contrary, while after intervening, the effect was better than which of only using restraint. Therewere few high quality research related to this field in both domestic and foreign countries, thus more well-designedclinical trials are needed to identify the influence of physical restraint in preventing unplanned extubation.