颅脑损伤病人急救阶段实施临床护理路径效果的Meta分析

Effect of clinical nursing pathway in the first aid stage of patients with craniocerebral injury:a Meta-analysis

目的:探讨临床护理路径在颅脑损伤病人急救阶段的实施效果。方法:检索PubMed、EMbase、Cochrane Library、Web of Science、中国知网、万方数据库、维普数据库和中国生物医学文献数据库,查找从建库至2020年11月1日关于临床护理路径在颅脑损伤病人急救阶段应用效果的临床随机对照试验(RCT),根据纳入与排除标准筛选文献。采用Cochrane手册5.1.0进行质量评价,运用RevMan 5.3软件进行统计分析。结果:最终纳入文献13篇,涉及1221例病人,临床护理路径组(试验组)613例,常规护理组(对照组)608例。Meta分析结果显示,试验组与对照组比较,抢救时间[MD=-13.68,95%CI(-17.37,-9.98),P<0.00001]、抢救费用[MD=-134.83,95%CI(-187.04,-82.62),P<0.00001]、并发症发生率[OR=0.26,95%CI(0.14,0.50),P<0.0001]、护理满意度[OR=5.97,95%CI(3.85,9.27),P<0.00001]及抢救成功率[OR=3.36,95%CI(2.08,5.40),P<0.00001]差异均有统计学意义。结论:现有证据表明,临床护理路径能明显缩短颅脑损伤病人在急救阶段的抢救时间,降低抢救费用,减少并发症发生率,提高抢救成功率,增加病人及家属的护理满意度。

Objective:To explore the effect of clinical nursing pathway in the first aid stage of patients with craniocerebral injury.Methods:Randomized controlled trial study on clinical nursing pathway in first aid stage of patients with craniocerebral injury were retrieved from PubMed,EMbase,the Cochrane Library,Web of Science,CNKI,WanFang,VIP and CBM.The retrieval time is from the establishment of each database to November 1,2020.Qualified studies were screened according to inclusion and exclusion criteria.The Cochrane Handbook5.1.0 was used for quality evaluation,and RevMan 5.3 software was used for statisical analysis.Results:A total of 1221 patients were included in 13 papers,including 613 patients in clinical nursing pathway group(experimental group)and 608 patients in conventional nursing group(control group).Meta-analysis results showed that compared with the control group,in the rescue time[MD=-13.68,95%CI(-17.37,-9.98),P<0.00001],rescue cost[MD=-134.83,95%CI(-187.04,-82.62),P<0.00001],complication rate[OR=0.26,95%CI(0.14,0.50),P<0.0001],nursing satisfaction[OR=5.97,95%CI(3.85,9.27),P<0.00001],rescue success rate[OR=3.36,95%CI(2.08,5.40),P<0.00001]in experimental group,the difference was statistically significant.Conclusion:Current evidence suggests that the clinical nursing pathway can significantly shorten the rescue time of patients with craniocerebral injury in the first aid stage,reduce the cost of rescue,reduce the incidence of complications,increase the success rate of rescue,and increase the satisfaction of patients and their families.