Background: Early mobilization(EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta...Background: Early mobilization(EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta-analysis concerning whether EM could benefit the clinical outcomes of critically ill patients requiring mechanical ventilation(MV). The present systematic review aims to evaluate the effect of EM compared with immobilization for mechanically ventilated patients.Methods: A computerized literature search was performed in six databases for related articles from inception to June 2017. We included randomized controlled trials and controlled clinical trials and used the Physiotherapy Evidence Database scale to assess the quality of included studies. Primary outcomes were measures of muscle function, duration of MV, and incidence of mortality.Secondary outcomes were adverse effects and length of stay(LOS) in intensive care unit(ICU) and hospital.Results: Eight trials were included; of those, only one study without standard EM reported that the intervention was invalid to improve the outcomes. The result of meta-analysis indicated that EM shortened the duration of MV; however, it had no positive effect on mortality and LOS in ICU.Conclusions: This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.展开更多
目的：系统评价转运中加热凝胶床垫对低体温早产儿复温效果的有效性和安全性。方法：计算机检索PubMed、EMBASE、Cochrane Library、Web of Science，中国生物文献数据库、中国学术期刊全文数据库、万方和维普等国内外数据库中有关加热...目的：系统评价转运中加热凝胶床垫对低体温早产儿复温效果的有效性和安全性。方法：计算机检索PubMed、EMBASE、Cochrane Library、Web of Science，中国生物文献数据库、中国学术期刊全文数据库、万方和维普等国内外数据库中有关加热凝胶床垫应用于早产儿低体温复温的随机对照试验或半随机试验。对获得文献根据纳入与排除标准进行文献筛查、资料提取、文献质量评价，采用RevMan513统计软件进行Meta分析，采用丹麦哥本哈根临床试验中心开发的TSA v0．9软件进行试验序贯分析。结果：共纳入7篇随机对照试验，3篇类试验，共包括773例患儿。Meta分析结果显示，使用加热凝胶床垫入新生儿重症监护治疗病房（NICU）时体温[SMD=0．63，95％CI（0．40，0．87），P=0．00]、低体温发生率[RR=0．73，95％CI（0．57，0．93），P=0．01]、高热[RR=1．82，95％ClI（1．31，2．54），P=0．00]，合并效应有统计学意义；而在使用放热床垫、超温床垫进入NICU时体温，死亡率，脓毒血症，早期视网膜病变，3至4级脑室内出血方面并无统计学意义。试验序贯分析显示，入NICU时体温和高温指标Meta分析结果稳定且可靠，但低温发生率、死亡率指标合并结果提示样本量不足。结论：加热凝胶类型床垫是安全有效的复温辅助干预措施，可提高转运过程中低温早产儿入NICU时体温，降低低体温发生率且不增加死亡率和并发症的发生率，但建议临床使用时应动态监测体温以降低高热的潜在风险。此外，其成本效益和对远期结局指标的长期影响需要通过临床多中心、大样本、高质量的研究进一步评价。展开更多
文摘Background: Early mobilization(EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta-analysis concerning whether EM could benefit the clinical outcomes of critically ill patients requiring mechanical ventilation(MV). The present systematic review aims to evaluate the effect of EM compared with immobilization for mechanically ventilated patients.Methods: A computerized literature search was performed in six databases for related articles from inception to June 2017. We included randomized controlled trials and controlled clinical trials and used the Physiotherapy Evidence Database scale to assess the quality of included studies. Primary outcomes were measures of muscle function, duration of MV, and incidence of mortality.Secondary outcomes were adverse effects and length of stay(LOS) in intensive care unit(ICU) and hospital.Results: Eight trials were included; of those, only one study without standard EM reported that the intervention was invalid to improve the outcomes. The result of meta-analysis indicated that EM shortened the duration of MV; however, it had no positive effect on mortality and LOS in ICU.Conclusions: This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.
文摘目的：系统评价转运中加热凝胶床垫对低体温早产儿复温效果的有效性和安全性。方法：计算机检索PubMed、EMBASE、Cochrane Library、Web of Science，中国生物文献数据库、中国学术期刊全文数据库、万方和维普等国内外数据库中有关加热凝胶床垫应用于早产儿低体温复温的随机对照试验或半随机试验。对获得文献根据纳入与排除标准进行文献筛查、资料提取、文献质量评价，采用RevMan513统计软件进行Meta分析，采用丹麦哥本哈根临床试验中心开发的TSA v0．9软件进行试验序贯分析。结果：共纳入7篇随机对照试验，3篇类试验，共包括773例患儿。Meta分析结果显示，使用加热凝胶床垫入新生儿重症监护治疗病房（NICU）时体温[SMD=0．63，95％CI（0．40，0．87），P=0．00]、低体温发生率[RR=0．73，95％CI（0．57，0．93），P=0．01]、高热[RR=1．82，95％ClI（1．31，2．54），P=0．00]，合并效应有统计学意义；而在使用放热床垫、超温床垫进入NICU时体温，死亡率，脓毒血症，早期视网膜病变，3至4级脑室内出血方面并无统计学意义。试验序贯分析显示，入NICU时体温和高温指标Meta分析结果稳定且可靠，但低温发生率、死亡率指标合并结果提示样本量不足。结论：加热凝胶类型床垫是安全有效的复温辅助干预措施，可提高转运过程中低温早产儿入NICU时体温，降低低体温发生率且不增加死亡率和并发症的发生率，但建议临床使用时应动态监测体温以降低高热的潜在风险。此外，其成本效益和对远期结局指标的长期影响需要通过临床多中心、大样本、高质量的研究进一步评价。
