9种护理方案对ICU病人失禁相关性皮炎预防及疗效的网状Meta分析

Prevention and therapeutic effects of 9 nursing plans on incontinence-associated dermatitis in ICU patients:a network Meta-analysis

目的:通过网状Meta分析评价9种护理方案对重症监护室(ICU)病人失禁相关性皮炎(IAD)发生率、发生时间和愈合时间的影响。方法:检索PubMed、MedLine、Web of Science、the Cochrane Library、EMbase、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(WanFang Database)、维普数据库(VIP)中关于不同护理方案干预ICU病人IAD的发生率、发生时间和愈合时间的随机对照试验(RCT)。检索时限从建库至2023年6月。采用Stata 16.0进行网状Meta分析。结果:纳入47篇文献,总样本量为6351例,共涉及9种ICU护理方案。网状Meta分析结果表明,采用结构化护理[OR=0.18,95%CI(0.09,0.34)]、集束化护理[OR=0.22,95%CI(0.15,0.34)]、失效模式和效应分析模式护理(FMEA)[OR=0.25,95%CI(0.14,0.46)]、综合护理[OR=0.28,95%CI(0.17,0.47)]、分级护理[OR=0.32,95%CI(0.20,0.52)]、前瞻性护理[OR=0.34,95%CI(0.24,0.47)]、标准化护理[OR=0.37,95%CI(0.23,0.58)]、4R危机理论护理[OR=0.39,95%CI(0.25,0.59)]在降低IAD发生率方面优于常规护理;结构化护理在降低IAD发生率方面优于4R危机理论护理[OR=0.46,95%CI(0.22,0.99)]。前瞻性护理在延缓IAD发生时间方面优于4R危机理论护理[MD=2.38,95%CI(0.13,4.63)]、常规护理[MD=3.33,95%CI(2.03,4.64)]、FMEA护理[MD=5.53,95%CI(2.08,8.99)];标准化护理在延缓IAD发生时间方面优于FMEA护理[MD=4.64,95%CI(0.13,9.15)]。前瞻性护理在加快IAD愈合方面优于结构化护理[MD=-4.73,95%CI(-9.33,-0.13)]、集束化护理[MD=-5.37,95%CI(-9.22,-1.51)]、分级护理[MD=-5.77,95%CI(-9.63,-1.91)]、FMEA护理[MD=-6.35,95%CI(-11.99,-0.71)]、4R危机理论护理[MD=-6.47,95%CI(-11.09,-1.84)]、标准化护理[MD=-7.24,95%CI(-11.44,-3.05)]、综合护理[MD=-7.72,95%CI(-13.36,-2.07)]、常规护理[MD=-8.73,95%CI(-11.99,-5.47)];结构化护理[MD=-4.00,95%CI(-7.25,-0.75)]、集束化护理[MD=-3.36,95%CI(-5.41,-1.31)]、分级护理[MD=-2.96,95%CI(-5.03,-0.89)]在加快IAD愈合方面优于常规护理。结论:现有证据表明,结构化护理、集束化护理、前瞻性护理对于ICU病人IAD的预防和治疗方面均显示出了各自的优势,临床上应根据科室及病人的整体情况,科学有效地制定最佳的护理策略。

Objective:To evaluate the effects of 9 nursing regimens on the incidence,onset time and healing time of IAD in ICU patients through mesh Meta-analysis.Methods:RCTs on the incidence,timing,and healing time of IAD in ICU patients with nursing interventions were retrieved from PubMed,MedLine,Web of Science,the Cochrane Library,EMbase,CNKI,CBM,WanFang Database,and VIP.The search deadline was from the establishment of each database to June 2023.Stata 16.0 was used for mesh Meta-analysis.Results:A total of 47 articles were included,with a total sample size of 6351 cases,involving a total of 9 ICU nursing plans.The results of mesh Meta-analysis showed that structured nursing(OR=0.18,95%CI 0.09-0.34),cluster nursing(OR=0.22,95%CI 0.15-0.34),FMEA nursing(OR=0.25,95%CI 0.14-0.46),comprehensive nursing(OR=0.28,95%CI 0.17-0.47),graded nursing(OR=0.32,95%CI 0.20-0.52),prospective nursing(OR=0.34,95%CI 0.24-0.47),standardized nursing(OR=0.37,95%CI 0.23-0.58)and 4R crisis theory nursing(OR=0.39,95%CI 0.25-0.59)were superior to conventional nursing in reducing the incidence of IAD.Structured nursing is superior to 4R crisis theoretical nursing in reducing the incidence of IAD(OR=0.46,95%CI 0.22-0.99).Prospective nursing was superior to 4R crisis theoretical nursing(MD=2.38,95%CI 0.13-4.63),conventional nursing(MD=3.33,95%CI 2.03-4.64)and FMEA nursing(MD=5.53,95%CI 2.08-8.99)in delaying the onset of IAD.Standardized nursing was better than FMEA nursing in delaying the onset of IAD(MD=4.64,95%CI 0.13-9.15).Prospective nursing was superior to structured nursing(MD=-4.73,95%CI-9.33--0.13),clustered nursing(MD=-5.37,95%CI-9.22--1.51),graded nursing(MD=-5.77,95%CI-9.63--1.91),FMEA nursing(MD=-6.35,95%CI-11.99--0.71),4R crisis theory nursing(MD=-6.47,95%CI-11.09--1.84),standardized nursing(MD=-7.24,95%CI-11.44--3.05),comprehensive nursing(MD=-7.72,95%CI-13.36--2.07)and routine nursing(MD=-8.73,95%CI-11.99--5.47)in accelerating IAD healing.Structured nursing(MD=-4.00,95%CI-7.25--0.75),cluster nursing(MD=-3.36,95%CI-5.41--1.31)and graded nursing(MD=-2.96,95%CI-5.03--0.89)were superior to conventional nursing in accelerating IAD healing.Conclusion:The existing evidence shows that structured nursing,cluster nursing and prospective nursing show their respective advantages in the prevention and treatment of IAD in ICU patients,and the best nursing strategy should be scientifically and effectively formulated according to the overall situation of the department and patients.