临床护理路径在我国肝癌介入治疗术后患者中应用效果的Meta分析

Clinical Nursing Pathways in Primary Liver Cancer Interventional Therapy:A Meta-analysis of Application in China

目的采用Meta分析探讨临床护理路径对我国肝癌患者介入治疗术后的影响。方法计算机检索1990年1月—2013年10月国内中文科技期刊全文数据库、万方数据库、维普中文期刊全文数据库、中国生物医学文献数据库中关于临床护理路径对肝癌患者介入治疗术后影响的文献,按纳入及排除标准筛选文献并进行质量评价,采用Rev Man 5.1.2软件处理,对所纳入文献进行Meta分析。结果共纳入11篇文献,包含受试者904例,其中干预组449例,对照组455例。1篇文献质量评价为B级,其余文献均为C级。Meta分析结果显示,干预组尿潴留发生率低于对照组〔RR=0.29,95%CI(0.16,0.52),P<0.000 1〕;干预组恶心呕吐发生率低于对照组〔RR=0.26,95%CI(0.18,0.36),P<0.000 01〕;干预组腰酸背痛发生率低于对照组〔RR=0.43,95%CI(0.32,0.57),P<0.00001〕;干预组负性情绪发生率低于对照组〔RR=0.42,95%CI(0.30,0.58),P<0.000 01〕;干预组失眠发生率低于对照组〔RR=0.38,95%CI(0.28,0.52),P<0.000 01〕;两组穿刺处出血、血肿发生率间差异无统计学意义〔RR=0.50,95%CI(0.17,1.43),P=0.20〕;干预组术后卧床时间短于对照组〔WMD=-6.74,95%CI(-7.95,-5.53),P<0.000 01〕;干预组住院天数短于对照组〔WMD=-3.41,95%CI(-3.97,-2.58),P<0.000 01〕;干预组住院费用少于对照组〔WMD=-2 197.41,95%CI(-2 894.55,-1 500.27),P<0.000 01〕;干预组健康知识得分高于对照组〔WMD=7.00,95%CI(4.63,9.38),P<0.000 01〕。干预组对护理满意率高于对照组〔RR=1.18,95%CI(1.03,1.34),P=0.02〕。结论临床护理路径对肝癌患者介入治疗术后的整体舒适度优于传统护理方法且不会增加并发症的发生,但由于纳入文献质量较低,需要更多高质量的研究来进一步验证临床护理路径对肝癌患者的影响。

Objective To evaluate the therapeutic effect of clinical nursing pathway（ CNP） on primary liver cancer interventional therapy by Meta-analysis. Methods This study retrieved the main domestic databases（ CNKI, WANFANG DATA,VIP,CBM） for relevant literatures from January 1990 to October 2013,evaluated the quality of enrolled studies and carried out a Meta-analysis on them. Results A total of 11 literatures were enrolled, including 904 subjects（ 449 in test groups,455 in control groups）. The quality of 1 literature was B-class,those of the others were all C-class. By Meta-analysis,the incidence of urinary retention was lower in test groups than in control groups〔RR = 0. 29,95% CI（ 0. 16,0. 52）,P〈0. 000 1〕,that of nausea and vomiting lower 〔RR = 0. 26,95% CI（ 0. 18,0. 36）,P〈0. 000 01 〕,that of ache in the waist and back lower〔RR = 0. 43,95% CI（ 0. 32,0. 57）,P〈0. 000 01〕,that of negative emotion lower〔RR = 0. 42,95%CI（ 0. 30,0. 58）,P〈0. 000 01〕,that of sleeplessness lower〔RR = 0. 38,95% CI（ 0. 28,0. 52）,P〈0. 000 01〕. There was no significant difference in incidence of bleeding / hematoma on puncture site between 2 groups〔RR = 0. 50,95% CI（ 0. 17,1. 43）,P = 0. 20〕. The time in bed was shorter in test groups than in control groups 〔WMD =-6. 74,95% CI（-7. 95,-5. 53）,P〈0. 000 01〕,the hospital stay shorter〔WMD =-3. 41,95% CI（-3. 97,-2. 58）,P〈0. 000 01〕,the hos-pital costs lower 〔WMD =-2 197. 41,95% CI（-2 894. 55,-1 500. 27）,P〈0. 000 01 〕,the scores of health knowledge higher 〔WMD = 7. 00,95% CI（ 4. 63,9. 38）, P〈0. 000 01 〕, the nursing satisfaction rate higher 〔RR = 1. 18,95% CI（ 1. 03,1. 34）,P = 0. 02〕. Conclusion The overall comfort level of CNP is superior to that of traditional nursing method without any increase of complications. But because of the low quality of the enrolled literatures,more researches needed to validate further the effects of CNP on liver cancer patients.