直立性低血压非药物护理干预的系统性回顾分析

目的:有关直立性低血压治疗的大规模随机临床试验较少,并且结果差异较大。本文拟回顾分析有关直立性低血压非药物干预措施的疗效,为护理方案的制定提供依据。方法:计算机检索Pub Med、Cumulative Index to Nursing and Allied Health Literature、Embase、Cochrane Central Register of Controlled Trials、《中国生物医学文献数据库》(CBMdisc)、OVID、Elsevier中关于饮食、护理、非药物疗法、康复等对直立性低血压进行干预的随机对照试验。检索时限为1980.01至今。采用描述性统计学方法,采用PEDro量表和Sackett证据等级对各研究质量进行评价。结果:共筛选出24项随机对照试验。分析显示,脊髓损伤时的功能性电刺激、下肢和(或)腹部加压、物理对抗动作、慢性自主神经衰竭时的少量多餐等非药物干预措施对直立性低血压有效(证据等级1级)。休息时抬高头位、快速大量饮水、运动(阻抗训练)等无效或证据等级较低(2~4级)。结论:对于直立性低血压患者,建议加强患者教育,指导患者进行功能性电刺激、下肢和(或)腹部加压、物理对抗动作、少量多餐等方面的训练。

Objectives:To investigate literatures on the nonpharmacologic treatment of orthostatic hypotension, since medical therapy brings about a higher rate of adverse events.Methods:Pub Med, Cumulative Index to Nursing and Allied Health Literature, Embase,Cochrane Central Register of Controlled Trials, CBMdisc, OVID and Elsevier were searched for human studies written in the English language between January 1980 and September 2015.Controlled studies assessing nonpharmacologic interventions for orthostatic drop in blood pressure were included. Descriptive comparisons were subsequently drawn.Results:Of the 629 studies, 24 met the inclusion criteria.Levels of evidence were assigned for these studies. Strong levels of evidence were found for 4 interventions: functional electrical stimulation in spinal cord injury, compression of the legs and/or abdomen, physical countermaneuvers, and eating smaller and more frequent meals in chronic autonomic failure.Conclusions: As for nurses, more efforts should be made for patient education of orthostatic hypotension and training of functional electrical stimulation, limb and abdominal compression, physical countermaneuvers and eating habits.