基于多学科协作的缓和医疗在心力衰竭患者中应用的Meta分析

Meta-analysis of application of palliative care based on multidisciplinary cooperation in patients with heart failure

目的评价基于多学科协作的缓和医疗在心力衰竭患者中的应用效果。方法计算机检索PubMed、Embase、CINAHL、The Cochrane Library、中国生物医学文献数据库、中国知网、万方数据库、维普等中英文数据库中有关心力衰竭患者实施缓和医疗的随机对照试验, 检索时限为建库至2020年12月31日。由2名研究者独立筛选文献、提取资料并进行质量评价, 采用RevMan 5.4软件对纳入研究进行Meta分析。结果共纳入12项研究, 包括1 402例患者。Meta分析结果显示:与常规管理相比, 基于多学科协作的缓和医疗能够改善心力衰竭患者的生活质量(SMD=0.72, 95%CI:0.32~1.11, P<0.01);减轻患者的症状负担(MD=-12.90, 95%CI:-20.25~-5.54, P<0.01);降低患者的抑郁水平(MD=-0.38, 95%CI:-0.69~-0.08, P<0.05)、焦虑水平(MD=-0.35, 95%CI:-0.66~-0.05, P<0.05)、再住院率(RR=0.70, 95%CI:0.57~0.86, P<0.01);患者病死率的差异无统计学意义(RR=1.02, 95%CI:0.63~1.63, P=0.94)。结论基于多学科协作的缓和医疗能够改善心力衰竭患者的生活质量, 减轻患者的症状负担, 并能降低患者的抑郁水平、焦虑水平、再住院率, 而对降低患者的病死率则无明显作用。鉴于缓和医疗在我国尚处于起步阶段, 受纳入研究的质量和数量限制, 故仍需多中心、大样本、高质量的研究加以验证。

Objective To evaluate the application effect of palliative care based on multidisciplinary cooperation in patients with heart failure.Methods Randomized controlled trials of palliative care in patients with heart failure were searched by computer in PubMed,Embase,CINAHL,The Cochrane Library,China Biology Medicine disc,CNKI,Wanfang Database,VIP and other Chinese and English databases.The search time limit was from the establishment of the databases to December 31,2020.Two researchers independently screened the literature,extracted the data and evaluated the quality.RevMan 5.4 software was used to conduct a meta-analysis of the included studies.Results A total of 12 studies were included,including 1402 patients.Meta-analysis results showed that compared with conventional management,palliative care based on multidisciplinary collaboration could improve quality of life of patients with heart failure(SMD=0.72,95%CI:0.32-1.11,P<0.01),reduce the burden of symptoms on patients(MD=-12.90,95%CI:-20.25--5.54,P<0.01),and reduce depression level(MD=-0.38,95%CI:-3.69--0.08,P<0.05),anxiety level(MD=-0.35,95%CI:-0.66--0.05,P<0.05)and rehospitalization rate of patients(RR=0.70,95%CI:0.57-0.86,P<0.01).There was no statistically significant difference in mortality between patients(RR=1.02,95%CI:0.63-1.63,P=0.94).Conclusions Palliative care based on multidisciplinary collaboration can improve the quality of life of patients with heart failure,reduce the burden of symptoms,depression level and anxiety level and reduce the rehospitalization rate of patients,but it has no significant effect on reducing the mortality rate of patients.Given that palliative care is still in its infancy in China and is limited by the quality and quantity of included studies,the above conclusions need to be verified by more large-sample and high-quality studies.