延续性护理干预在食管癌术后患者应用效果的系统评价

Clinical efficacy of transitional care in the intervention for patients after esophageal carcinoma surgery:A systematic review of randomized controlled trials

目的系统评价延续性护理干预在食管癌术后患者中的应用效果。方法检索Pubmed、Cochane Library、Embase、维普、CBM、CNKI等数据库有关延续性护理在食管癌术后患者中的干预研究的RCT文献,采用改良Jadad量表进行质量评分,RevMan5.3.1软件进行统计分析。结果共纳入19篇随机对照试验,其中英文文献2篇,中文文献17篇。Meta分析结果显示:延续性护理相较于常规护理,能够提高治疗总有效率(RR=1.50,95%CI:1.12,2.00,P=0.006),改善患者生活质量(MD=16.91,95%CI:10.82,23.00,P<0.000 01),提高患者遵医率(RR=1.31,95%CI:1.13,1.51,P=0.000 3),降低并发症发生率(RR=0.53,95%CI:0.36,0.79,P=0.002),提高患者满意度(RR=1.22,95%CI:1.09,1.36,P=0.000 5)以及降低患者再入院率(RR=0.34,95%CI:0.14,0.84,P=0.02)。结论延续性护理干预在食管癌术后患者中的应用能够提高治疗总有效率,改善患者生活质量,但纳入文献质量不高,因此有必要开展此方面的高质量、大样本、多中心的随机对照试验。

Objective To study the clinical efficacy and superiority of transitional care on the postoperative treatment of patients with esophageal carcinoma surgery.Methods Randomized controlled trials（RCT）on the clinical efficacy and superiority of transitional care in the intervention treatment of patients after esophageal carcinoma surgery were reviewed from PubMed,Cochane Library,Embase,CNKI,CBM and VIP,from the earliest published articles to January 2017,all reviewed literatures were accessed by modified Jadad quality scale.Statistic data was analyzed by Rev Man5.3.1.Results This review contains 19 RCT studies（two English literature,17 Chinese literatures）.The meta-analysis indicated that compared with standard nursing,transitional care could effectively increasing the total effective rates（RR=1.50,95%CI：1.12,2.00,P=0.006）,improving the quality of life of patients（MD=16.91,95%CI：10.82,23.00,P〈0.00001）,enhancing the rate of treatment compliance of patients（RR=1.31,95%CI：1.13,1.51,P=0.0003）,and reducing the incidence of complications（RR=0.53,95%CI：0.36,0.79,P=0.002）,increasing the nursing satisfaction of the patients（RR=1.22,95%CI：1.09,1.36,P=0.0005）as well as decreasing the readmission rates（RR=0.34,95%CI：0.14,0.84,P=0.02）.Conclusion Transitional care in the intervention of patients after esophageal carcinoma surgery appears to have satisfactory efficacy and superiority,which is much more superior to any conventional nursing treatment.However,a clinical recommendation is not warranted due to the small number of studies included and low methodology quality.Multi-center and high-quality RCTs with large sample sizes are needed to provide stronger evidence.