早期活动对ICU获得性衰弱干预效果的Meta分析

Effect of Early Mobilization on the Prevention of Intensive Care Unit Acquired Weakness:A Meta-analysis

目的系统评价早期活动对ICU患者ICU获得性衰弱(intensive care unit acquired weakness,ICU-AW)的干预效果。方法计算机检索中国期刊全文数据库、中国生物医学文献数据库、万方数据库、Cochrane Library、Pubmed、Web of Science中有关早期活动预防ICU-AW的随机对照试验(randomized controlled trial,RCT),检索时间均为各数据库建库至2017年2月,同时追溯纳入研究的参考文献。两名研究者独立按纳入排除标准进行文献筛选、资料提取和质量评价后,采用RevMan5.3软件进行Meta分析。结果共纳入11篇RCT,985名患者,Meta分析结果显示:肌力(MRC-score)WMD=8.09,95%CI为(7.29,8.88)、ICU-AW发病率OR=0.11,95%CI为(0.04,0.35),巴氏评分WMD=23.6,95%CI为(14.61,32.59),机械通气时间SMD=-1.13,95%CI为(-1.68,-0.58),ICU住院时间SMD=-1.28,95%CI为(-1.99,-0.56),总住院时间SMD=-1.53,95%CI(-2.60,-0.46)。结论基于现有证据得出早期活动可减少ICU-AW的发病率,同时也能缩短机械通气时间、ICU住院时间和总的住院时间,值得临床推广应用。

Objective To evaluate the effect of early mobilization on preventing intensive care unit acquired weakness(ICU-AW).Methods We searched the following databases such as CNKI,CBM,WanFang Data,Cochrane Library,PubMed,Web of Science electronically for randomized controlled trials(RCT)of early mobilization for preventing ICU-AW from the database establishment to February 2017.Based on the inclusion criteria,literatures were selected and quality of all included studies was assessed by 2 reviewers independently.The extracted data was then analyzed by RevMan 5.3 software for Meta-analysis.Citations of included studies were also reviewed.Results Totally 11 RCTs with 985 patients were included.The results of Meta-analysis showed that WMD of muscle strength(MRC-score)was 8.09 with 95%CI(7.29,8.88),OR of incidence of ICU-AW was 0.11 with 95%CI(0.04,0.35),WMD of the Barthel Index was 23.6 with 95%CI(14.61,32.59),SMD of duration of mechanical ventilation was-1.13 with 95%CI(-1.68,-0.58),SMD of the length of stay in ICU was-1.28 with 95%CI(-1.99,-0.56)and the SMD of the total duration of hospitalization was-1.53 with 95%CI(-2.60,-0.46).Conclusion Based on the available evidence,it can be concluded that early activities can reduce the incidence of ICU-AW,shorten the duration of mechanical ventilation,length of stay in ICU and hospital,which is worthy of clinical application.