白内障手术患者舒适度的影响因素分析:系统综述和Meta分析

Factors Affecting the Comfort of Patients Undergoing Cataract Surgery:A Systematic Review and Meta-Analysis

目的:系统评价临床实践中影响白内障手术患者舒适度的因素,为提高白内障手术患者舒适度提供可靠依据。方法:计算机检索中文全文期刊数据库(CNKI)、万方数据库、维普数据库、PubMed、Embase、Cochrane Library搜集有关文章,2位评价者独立进行文献检索、筛选、质量评价及数据提取,采用RevMan 5.3软件进行Meta分析。结果:文章共纳入52篇随机对照研究中行白内障手术的患者12 911名,将影响白内障患者手术的因素进行分类,依次为护理方式、麻醉药物的种类及作用部位,未归入上述的影响因素按作用时间分为术前影响因素如是否口服镇静药物、术中影响因素如是否辅助吸氧、术后影响因素如术后是否盖眼垫等。将可进行数据分析的影响因素进行处理,Meta分析结果显示:与常规护理相比,协同护理可提高白内障手术患者舒适度相对危险度为1.21,95%置信区间( CI):1.13,1.30( P<0.001);与利多卡因相比,其他表面麻醉药在麻醉效果及影响患者舒适度方面无明显差异,均值差为-0.69,95% CI:-1.51,0.14( P<0.001);较平衡盐溶液相比,静脉输注芬太尼组可明显降低患者自控的镇痛装置按压给药的次数,进而反映出静脉输注芬太尼可提高患者舒适度[ MD=-1.77,95% CI:-2.19,-1.39;P<0.001];Tendon囊下麻醉较表面麻醉相比,麻醉效果及患者舒适度方面更好[ MD=-1.02,95% CI:-1.33,-0.71;P<0.001];其他可提升患者舒适度的因素由于研究文献少或统计结果难以合并遂未行Meta分析,但将其结论进行系统综述。 结论:影响白内障手术患者舒适度的因素较多,在临床中可逐步开展,进一步提高手术舒适度,提升患者生活质量。

Objective:The factors affecting the comfort of patients undergoing cataract surgery were systematically evaluated in order to provide a reliable basis for improving surgical comfort.Methods:The following databases were searched:China National Knowledge Infrastructure(CNKI),the Wanfang Database,the Vip Database,PubMed,Embase and Cochrane Library.Two researchers extracted data and independently assessed the quality of the articles.Meta-analysis was performed using RevMan 5.3 software.Results:A total of 12911 patients undergoing cataract surgery in 52 randomized controlled trials were included in this study.The factors affecting cataract surgery were classified and nursing methods,types of anesthetics and location where surgery was performed were also classified.Factors that could not be classified as above were divided into preoperative factors like oral sedation,intraoperative factors like auxiliary oxygen inhalation and postoperative factors such as postoperative eye pads and so on.Meta-analysis showed that compared with conventional nursing,collaborative nursing could improve the comfort of cataract patients with RR=1.21(95%CI:1.13,1.30,P<0.001).There was no significant difference in anesthetic effect or comfort between lidocaine and other topical anesthetics,MD=-0.69(95%CI:1.51,0.14,P<0.001).Compared to a balanced salt solution,an intravenous infusion of fentanyl could significantly reduce the frequency of pressing and administration of a patient-controlled analgesia device,which indicated that fentanyl could improve the comfort of patients,MD=-1.77(95%CI:2.19,-1.39,P<0.001).The anesthetic effect and patient comfort were better in the sub-Tenon's group than in the topical anesthesia group,MD=1.02(95%CI:1.33,0.71,P<0.001).Due to a lack of research literature or statistical results,it was difficult to perform other factors in meta-analysis,however,a systematic review was done.Conclusions:There are many factors affecting the comfort of cataract patients undergoing surgery which can be gradually promoted and applied in the clinic to improve the comfort of cataract surgery and the quality of life of patients.