9种护理模式在脑卒中吞咽障碍患者中应用效果的网状meta分析

A Reticular meta-analysis of the effect of 9 nursing modes in ischemic stroke patients with dysphagia

目的系统评价9种护理模式在脑卒中吞咽障碍患者中的应用效果。方法计算机检索PubMed、EMbase、The Cochrane Library、中国生物医学文献数据库、中国知网、维普和万方数据库,收集有关9种护理模式在脑卒中吞咽障碍患者中应用效果的随机对照试验(randomized controlled trials,RCT),检索时限均从建库至2022年1月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16.0软件和RevMan 5.4软件进行网状Meta分析。结果共纳入37个RCT,包括3426例脑卒中吞咽障碍患者和9种护理模式:家庭护理模式、延伸护理模式、中医护理模式、预见性护理模式、集束化护理模式、卒中单元护理模式、综合康复护理模式、早期康复护理模式、多学科协作护理模式。Meta分析结果显示,在脑卒中吞咽障碍患者康复总有效率方面,9种护理模式均优于常规护理模式(P<0.05),预见性护理模式排序最优,预见性护理模式和家庭护理模式与综合康复护理模式相比差异有统计学意义(P<0.05)。结论当前证据显示,预见性护理模式在提高脑卒中吞咽障碍患者康复总有效率方面可能更具有优势。受纳入研究数量和质量的限制,上述结论尚待更多大样本、高质量的研究予以验证。

Objective To systematically evaluate the effects of nine nursing models on ischemic stroke patients with dysphagia.Methods We searched PubMed,EMbase,the Cochrane Library,CBM,CNKI,VIP and WanFang Data databases to collect randomized controlled trials(RCTs)literature related to the application effects of nine nursing models in ischemic stroke patients with dysphagia from inception to January 2022.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of the included studies.Network meta-analysis was then performed using Stata 16.0 software and RevMan 5.4 software.Results A total of 37 RCTs involving nine nursing models:family nursing mode,extended nursing mode,traditional Chinese medicine nursing mode,predictive nursing mode,cluster nursing mode,stroke unit nursing mode,comprehensive rehabilitation nursing mode,early rehabilitation nursing mode and multidisciplinary cooperative nursing mode,were included in the study.Results of the meta-analysis showed that the nine nursing modes were better than the conventional nursing mode in terms of the total effective rate of rehabilitation for stroke patients with dysphagia(P<0.05).There was a significant difference between the predictive nursing mode and home nursing mode and the comprehensive rehabilitation nursing mode(P<0.05),and the predictive nursing mode ranked the best.Conclusion Current evidence shows that predictive nursing model may have more advantages in improving the total effective rate of rehabilitation of stroke patients with dysphagia.Due to limited quality and quantity of the included studies,more high-quality and large sample studies are needed to substantiate the above conclusion.