缓和医疗干预对老年痴呆病人的影响:一项系统评价及Meta分析

Effects of palliative care implementation on elderly patients with dementia:a systematic review and meta-analysis

目的 系统评价缓和医疗干预对老年痴呆病人生活质量、症状负担和护理偏好讨论的影响。方法 检索Embase、MEDLINE、CENTRAL、APA PsycInfo、CINAHL、Web of Science、ClinicalTrials.gov、中国生物医学文献数据库、中国期刊全文数据库、维普数据库、万方数据库,筛选针对痴呆病人实行缓和医疗干预的随机对照试验,评价纳入研究的偏倚风险,使用Stata 17.0 BE软件进行Meta分析。结果 最终纳入13项研究,共包含3394例痴呆病人(平均年龄为82.0岁,65.8%为女性)。Meta分析结果显示,与常规护理相比,缓和医疗与护理偏好讨论相关[共纳入5项研究,n=996;RR=2.11(95%CI1.14~3.90);I^(2)=87.3%],与生活质量提高[共纳入4项研究,n=762;标准化均数差(SMD)=-0.04(95%CI-0.43~0.35);I^(2)=79.7%]和症状改善[共纳入6项研究,n=1047;SMD=0.26(95%CI-0.06~0.58);I^(2)=80.8%]没有显著相关性。结论 与常规护理相比,缓和医疗与护理偏好讨论相关,与生活质量或症状的相关性方面证据不足。

Objective To systematically assess the effects of palliative care on quality of life,symptoms,and care preferences discussion in the elderly patients with dementia.Methods Embase,MEDLINE,CENTRAL,APA PsycInfo,CINAHL,Web of Science Core Collection,ClinicalTrials.gov Database,CBM,CNKI,VIP and Wanfang Data were searched to screen the randomized controlled trials of palliative medical intervention in the patients with dementia.The included studies were evaluated for risk of bias,and meta-analysis was performed using Stata 17.0 BE software.Results Finally,13 studies were enrolled,including 3394 cases of dementia(mean age 82.0 years;65.8%being female).Meta-analysis showed that,compared with usual care,palliative care was significantly related to the discussion of care preferences(5 trials,n=996;RR=2.11,95%CI 1.14-3.90;I2=87.3%),but not related to the improvement of quality of life[4 trials,n=762;SMD=-0.04(95%CI-0.43-0.35);I2=79.7%]and symptoms(6 trials,n=1047;SMD=0.26,95%CI-0.06-0.58;I2=80.8%).Conclusions Compared with usual care,palliative care is associated with the discussion of care preferences,and there is insufficient evidence of correlation with quality of life or symptoms.