护理预防脑卒中相关性肺炎临床效果的Meta分析

Meta-analysis of clinical effect of nursing intervention on stroke-associated pneumonia

[目的]了解集束化护理对脑卒中相关性肺炎的预防及临床疗效,为其探索更科学和适宜的护理决策。[方法]计算机检索建库以来到2017年10月前全文发表于Cochrane Library、PubMed、EMbase、CBM、CNKI、WanFang Data中的有关集束化护理预防脑卒中相关性肺炎的随机对照试验(RCT),筛选出符合纳入标准的文献及其参考文献,另手工检索进行补充,由2名研究者同时对文献质量进行评鉴和提取,并用RevMan 5.3软件对纳入的研究进行Meta分析,随后运用定量系统评价证据分级工具(GRADE)profiler3.6.1软件对其证据质量进行分级。[结果]共纳入14篇RCT共3 668例病人。Meta分析结果显示:使用集束化护理能有效预防脑卒中后相关性肺炎的发生[RR=0.53,95%CI(0.45,0.63),P<0.000 01],减少误吸发生率[RR=0.28,95%CI(0.17,0.46),P<0.000 01],从而改善病人临床结局。进行敏感性分析对原结果无本质改变;其死亡率无统计学意义;住院天数合并存在较大异质性,故放弃Meta分析,漏斗图不对称考虑存在发表性偏倚。GRADE分级系统显示:集束化护理对脑卒中相关性肺炎的预防疗效证据等级为极低级。[结论]对于脑卒中后病人实施集束化护理可在一定程度上预防脑卒中相关性肺炎和误吸的发生,但由于偏倚因素影响和研究质量普遍偏低的问题,证据质量为极低级,对于研究结果还需开展多中心、大样本的高质量RCT证实后方能推广于临床使用。

Objective:To understand the prevention and clinical efficacy of clustering nursing for stroke associated pneumonia,and to explore more scientific and appropriate nursing decisions.Methods:Literature and its references of randomized controlled trials(RCTs)on cluster nursing in the prevention of stroke associated pneumonia were retrieved in Cochrane Library,PubMed,EMbase,CBM,China National Knowledge Infrastructure(CNKI),and WanFang Database from the establishment of the database to October 2017;with supplement by hand.Two researchers simultaneously evaluated and extracted the quality of the literature,and used the RevMan 5.3 software was used to conduct a meta analysis of the included studies.The quality of the evidence was then graded using the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)profiler 3.6.1 software.Results:A total of 14 RCTs involving 3 668 patients were included in this study.Meta analysis results showed that the use of clustering nursing could effectively prevent pneumonia[RR=0.53,95%CI(0.45,0.63),P<0.000 01],reduce the incidence of aspiration[RR=0.28,95%CI(0.17,0.46),P<0.000 01],and thus improve the clinical outcome.The sensitivity analysis did not change the original results;the mortality rate was not statistically significant;the hospitalization stays combination had a large heterogeneity,so give up the meta analysis;the funnel plot asymmetry considered the existence of publication bias.The GRADE grading system showed that the level of evidence for the prevention of stroke related pneumonia was extremely low.Conclusions:The implementation of clustering nursing for post stroke patients could prevent the occurrence of stroke related pneumonia and aspiration in a certain degree,while the quality of evidence was extremely low due to the influence of bias factors and the low quality of research.The results still required a large multi center sample of high quality RCTs to be validated for clinical application.