集束化护理预防ICU获得性衰弱效果的Meta分析

The effect of Cluster nursing intervention on preventing ICU acquired weakness:A meta analysis

目的评价集束化护理对预防ICU获得性衰弱(ICU acquired weakness,ICU-AW)发生的效果,为临床应用提供证据支持。方法检索中英文数据库CNKI、CBM、万方医学网、PubMed、Embase、Web of Science、The Cochrane library中关于使用集束化护理措施干预ICU患者的随机对照试验,检索时间为建库至2020年9月20日。通过对文献进行筛选、资料完整提取及质量评价后,利用RevMan 5.3进行Meta分析。结果最终纳入8篇文献,包括1037例ICU患者,其中干预组518例,对照组519例。Meta分析结果显示,干预结束时,集束化护理干预组ICU-AW发生率低于对照组,差异有统计学意义(OR=0.27,95%CI:0.21~0.36,P<0.01);干预组肌力水平高于对照组,差异有统计学意义(MD=7.71,95%CI:6.61~8.81,P<0.01);干预组日常生活能力高于对照组,差异有统计学意义(MD=17.38,95%CI:9.79~24.97,P<0.01);干预组机械通气时间低于对照组,差异有统计学意义(MD=-2.71,95%CI:-3.57~-1.85,P<0.01);干预组ICU住院时间低于对照组,差异有统计学意义(MD=-2.97,95%CI:-4.09~-1.86,P<0.01)。结论集束化护理可有助于降低ICU患者获得性衰弱的发生率,促进患者日常生活能力的恢复,增强肌力,缩短机械通气及ICU住院时间,但未对其进行远期随访或报道,其长期效应有待进一步深入研究。

Objective Meta analysis of the effects of Cluster nursing intervention on preventing ICU acquired weakness(ICU-AW),and provide evidence support for clinical application.Methods Chinese and English databases were searched,including China National Knowledge Infrastructure(CNKI),China Biomedical Literature Service System(CBM),Wanfang Medical Network,PubMed,Embase,Web of Science,The Cochrane library.The time limitation is from the establishment of the database to September 20,2020.Then,we extracted the data and evaluated the quality of literature,RevMen 5.3 was used for Meta analysis.Results 8 randomized controlled trials were included,including 1037 ICU patients,518 in intervention group and 519 in control group.The results of Meta analysis showed that the incidence of ICU-AW in intervention group is lower than control group,and the difference was statistically significant(OR=0.27,95%CI:0.21-0.36,P<0.01);The muscle strength level in intervention group is higher than control group,and the difference was statistically significant(MD=7.71,95%CI:6.61-8.81,P<0.01);The ability of daily living of intervention group is higher than control group,and the difference was statistically significant(MD=17.38,95%CI:9.79-24.97,P<0.01);The time of mechanical ventilation in intervention group was shorter than control group,and the difference was statistically significant(MD=-2.71,95%CI:-3.57--1.85,P<0.01);The length of stay in ICU in intervention group was shorter than control group,and the difference was statistically significant:(MD=-2.97,95%CI:-4.09--1.86,P<0.01).Conclusion Cluster nursing intervention may help reduce the incidence of ICU-AW in ICU patients,promote the recovery of the ability of daily living,strengthen muscle strength,shorten mechanical ventilation time and ICU hospital stay,but no long-term result was followed-up or reported,so its long-term effects needed to be further studied.