出院计划对脑卒中患者及其照顾者干预效果的系统评价

Efficacy of discharge planning on stroke patients and their caregivers

目的系统评价出院计划对脑卒中患者及其照顾者的干预效果。方法计算机检索建库至2016年3月公开发表在Pub Med、MEDLINE(Ovid)、CINAHL、The Cochrane Library、CNKI、万方、CBM等数据库的文献,收集所有出院计划对比常规出院护理应用于脑卒中患者的随机对照试验及半随机对照试验。由2名研究者按照纳入和排除标准,独立进行数据提取和文献评价。采用Rev Man 5.3软件进行Meta分析。结果共纳入15篇文献,相较于常规出院护理,出院计划能缩短脑卒中患者的住院时长[MD=-4.79,95%(-6.95,-2.63),Z=4.35,P<0.000 1],改善其出院3个月内的自理能力[MD=9.03,95%(1.73,16.33),Z=2.42,P=0.02]及提高护理满意度[OR=1.99,95%(1.20,3.30),Z=2.66,P=0.008],但照顾者负荷及护理满意度差异无统计学意义(P>0.05)。结论出院计划对脑卒中患者的实施效果优于常规出院护理,可减少患者住院时间,提高患者的自理能力及护理满意度,是一种可行的临床护理模式。

Objective To systematically review the efficacy of discharge planning on the stroke patients and their caregivers. Methods Databases including PubMed, MEDLINE （Ovid）, CINAHL, The Cochrane Library, CNKI, Wanfang Data and CBM were used to collect the randomized controlled trials （RCTs） or quasi- randomized control trims （quasi-RCTs） involving the comparison of discharge planning with routine nursing in stroke patients. The retrieval time was from inception to March 2016. The studies were selected according to the inclusion and exclusion criteria and the quality of included studies was evaluated by two reviewers. RevMan 5.3 was used for the meta-analysis. Results Totally 15 literatures were included in meta-analysis. The results showed that, compared with the routine nursing, the discharge planning could shorten hospital stay [ MD = - 4.79, 95% （ - 6.95, - 2.63 ）, Z = 4.35, P 〈 0. 000 1 ], improve activities of daily living three months after discharge [ MD = 9.03, 95% （ 1.73,16.33）, Z = 2.42, P = 0.02 ] and increase patient satisfaction [ OR = 1.99, 95 % （ 1.20, 3.30）, Z = 2.66, P = 0. 008 ]. No significant difference was found between discharge planning group and control group in caregiver workload and satisfaction （P 〉 0. 05 ）. Conclusion Discharge planning had better efficacy than routine nursing and it is a feasible nursing mode.