动机性访谈对高血压患者血压控制与服药依从性影响的Meta分析

Effects of Motivational Interviewing on Blood Pressure Control and Medication Compliance with Hypertension Patients:A Meta-analysis

目的评价动机性访谈(motivational interviewing,MI)对高血压患者血压控制与服药依从性的影响。方法计算机检索PubMed、荷兰医学文摘数据库(the excerpta medica database,Embase)、Medline、ScienceDirect、OVID(the offshore vessel inspection database)、Cochrane图书馆、中国期刊全文数据库(Chinese national knowledge infrastructure,CNKI)、万方数据库、中国生物医学数据库(Chinese biomedical literature database,CBM)、维普期刊资源整合服务平台,结合手工检索相关图书和杂志,搜集MI对高血压患者血压控制与服药依从性效果的随机对照实验(randomized controlled trial,RCT),检索时间为数据库建立初至2016年3月,采用RevMan 5.0统计软件进行数据分析。结果共纳入12个RCT,2543例患者。Meta分析结果显示,12个月内MI能够有效控制高血压患者的收缩压[MD=-3.40,95%CI(-4.28,-2.53),P<0.0001],同时可提高患者的服药依从性[OR=3.97,95%CI(1.80,8.75),P=0.0006]。3、12个月时,观察组和对照组对舒张压控制效果的差异均无统计学意义(均P>0.05)。6个月时结果显示,观察组患者控制舒张压的效果优于对照组[MD=-1.58,95%CI(-2.53,-0.63),P=0.001];总体舒张压值显示,观察组患者的干预效果优于对照组,差异有统计学意义[MD=-1.13,95%CI(-1.89,-0.36),P=0.004]。结论 MI能提高高血压患者的服药依从性,同时有效控制并且维持患者的血压,但仍需开展更多高质量的RCT予以验证。

Objective To evaluate the effects of motivational interviewing（MI） on blood pressure control and medi- cation compliance with hypertension.Methods Databases including PubMed, Embase, Medline, ScienceDirect, OV- ID, The Cochrane Library, CNKI, WanFang Data, CBM, VIP were searched to collect randomized controlled trials （RCTs） about effects of motivational interviewing on blood pressure control and medication compliance with hypertension, and relevant books and magazines were retrived.The databases were electronically searched from estab- lishment to March 2016.The data was extracted and analyzed by using RevMan 5.0 software.Results A total of 12 RCTs involving 2543 patients with hypertension were included.The results of meta analysis showed that within 12 months of MI, the systolic pressure diastolic of hypertension patients was controlled effectively[MD =- 3.40,95 %CI （-4.28,-2.53） ,P^0.0001],and improved medication compliance [OR：3.97, 95%CI（1.80,8.75）,P=0.0006].The diastolic blood pressure control of intervention group and the control group at 3 and 12 months, the difference was not statistically significant（all P〉0.05）.The outcomes at 6 months showed that the diastolic pressure effects of experi- mental group were better than that of control group [MD= -- 1.58,95＆CI （-2.53, -0.63）, P = 0.001].Overall dias- tolic pressure showed that the effect of the intervention group was better than the control group, the difference was statistically significant [MD=-1. 13,95 % CI （ - 1. 89, -0.36）, P = 0.004]. Conclusions MI can improve the medica- tion compliance of patients with hypertension, and can control and maintain their blood pressure effectively.But more high quality RCTs are needed to verify the above conclusions.