中国哮喘儿童治疗依从性影响因素的Meta分析

Meta-Analysis of Influencing Factors of Treatment Compliance in Children with Asthma in China

目的:系统评价中国哮喘儿童治疗依从性的影响因素。方法:计算机检索the Cochrane Library、EMBase、PubMed、Web of Science、中国知网、中国生物医学文献数据库、万方数据库及维普数据库,收集有关中国哮喘儿童治疗依从性影响因素的观察性研究,检索时间为建库至2023年3月31日。由2名研究者独立筛选文献、提取资料并根据JBI循证卫生保健中心推荐的质量评价工具进行偏倚风险评估后,采用Stata 17.0和RevMan 5.3软件进行Meta分析。结果:纳入30项研究,共计5285例患儿,包括15项横断面研究和15项病例对照研究。Meta分析结果显示,中国哮喘儿童治疗依从率为41.1%,照顾者认知水平低、药物不良反应、不良心理反应、吸入技术差是影响治疗依从性的危险因素;哮喘儿童症状严重是治疗依从性的保护因素;照顾者文化程度、患儿年龄、经济条件、医护监督、病程、照顾者对医护人员信任度与治疗依从性无关。结论:中国哮喘儿童治疗依从性较差,建议医护人员针对可改善的影响因素,如照顾者认知水平低、不良心理反应、吸入技术差等制定干预措施,提高哮喘儿童治疗依从性。

Objective:To systematically evaluate influencing factors of treatment compliance in children with asthma in China.Methods:The Cochrane Library,EMBase,PubMed,Web of Science,CNKI,CBM,Wanfang and VIP databases were retrieved for collecting observational studies on influencing factors of treatment compliance in children with asthma in China.The retrieval time was from the establishment of the database to Mar.31st,2023.Two researchers independently screened literature,extracted data,and assessed bias risks based on the quality assessment tool recommended by the Joanna Briggs Institute(JBI)Center for Evidence-Based Healthcare.Meta-analysis was performed by using Stata 17.0 and RevMan 5.3 software.Results:A total of 30 studies were enrolled,including 5,285 cases of children,with 15 cross-sectional studies and 15 case-control studies.Meta-analysis showed that the treatment compliance rate in children with asthma in China was 41.1%.Factors such as low caregiver cognitive level,adverse drug reactions,adverse psychological reactions and poor inhalation technique were identified as risk factors for treatment compliance.The severity of asthma symptoms was identified as a protective factor for treatment compliance.Caregiver education level,children’s age,economic status,medical supervision,duration of illness,and caregiver trust in clinicians and nurses were found to be unrelated to treatment compliance.Conclusion:Treatment compliance is poor in children with asthma in China,it is suggested that clinicians and nurses develop interventions targeting modifiable factors,such as low caregiver cognitive level,adverse psychological reactions and poor inhalation technique,to improve treatment compliance in children with asthma in China.