集束化护理预防ICU患者呼吸机相关性肺炎的meta分析  

Effect of bundle care on preventing ventilator-associated pneumonia in adult intensive care units:a Meta-analysis

作　　者：吴佼佼[1] 马红梅[1] 廖春霞[1] 张倩[1] 徐旭[1] WU Jiao-jiao MA Hong-mei LIAO Chun-xia ZHANG Qian XU Xu(Geriatric Department, Wuhan University Renmin Hospital, Wuhan Hubei, 430060,Chin)

机构地区：[1]武汉大学人民医院老年科,湖北武汉430060

出　　处：《职业与健康》2016年第24期3336-3340,共5页Occupation and Health

基　　金：湖北省自然科学基金(2015CKB754)

摘　　要：目的评估集束化护理干预与传统护理干预在预防重症监护室(ICU)患者呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的效果。方法计算机检索Cochrane Library、Pub Med、Web of Science、CNKI、VIP、万方数据库,查找所有比较集束化护理干预与传统护理干预在预防ICU患者AP的随机对照试验(RCT)。检索时限均为建库至2016年2月6日,按照纳入标准,两位研究者独立对RCT进行筛选、资料提取和质量评价后,采用Rev Man 5.1软件进行meta分析。结果最终纳入15个研究。共有5 357名受试者(其中试验组即集束化护理干预组2 420例,对照组即常规护理组2 937例)。meta分析结果显示:1VAP发生率:与对照组相比,试验组VAP的发生率要低(OR=0.41,95%CI为0.35~0.48,P<0.01);2ICU住院时间:试验组ICU住院时间较对照组短(MD=-4.88,95%CI为-6.47^-3.29,P<0.01);3病死率:试验组较对照组低(OR=0.40,95%CI为0.21~0.75,P<0.01);4机械通气时间:试验组较对照组短(MD=-4.21,95%CI为-5.49^-2.93,P<0.01);5满意度:试验组较对照组满意度要高(OR=4.55,95%CI为1.62~12.76,P<0.01)。结论集束化护理干预在预防ICU患者VAP时作用显著,可以降低患者VAP感染率,缩短ICU住院时间,降低患者病死率,减短患者所需机械通气时间,增加患者满意度,但因原始研究质量不高,需要更多高质量RCT进一步论证。[Objective]To evaluate the effect of bundle care and traditional nursing on preventing ventilator-associated pneumonia（VAP）in adult intensive care units（ICU）.[Methods]Such database as Cochrane Library,Pub Med,Web of Science,CNKI,VIP and Wanfang were searched from their establishment to 6 February,2016 for collecting the randomized controlled trials（RCTs）about bundle care versus traditional care on preventing VAP in ICU. Two reviewers independently did the study selection,assessment and data extraction according to the inclusion criteria. The Rev Man 5.1 software was used for meta-analysis.[Results]Fifteen studies involving 5 357 patients（2 420 in the experimental group and 2 937 in the control group）were included.The results of meta-analyses showed that compared with the control group, 1 the incidence of VAP in the experimental group decreased[OR=0.41,95%CI（0.35,0.48）,P0.01],2 the hospital stay in ICU shortened[MD=-4.88,95%CI（-6.47--3.29）,P0.01],3 the morbidity of VAP decreased[OR=0.40,95%CI（0.21-0.75）,P0.01],4 the mechanical ventilation time shortened[MD=-4.21,95%CI（-5.49--2.93）,P0.01],and the patients＇ satisfaction increased[OR=4.55,95%CI（1.62-12.76）,P0.01].[Conclusion]Bundle care intervention measures can significantly reduce incidence of VAP,hospital stay in ICU,the morbidity of VAP and the mechanical ventilation time,and improve the satisfaction of the basic quality of care. However,because of the poor quality of the original studies,more high-quality randomized controlled trials are needed in the future study.

关 键 词：集束化护理 呼吸机相关性肺炎 META分析 随机对照实验 

分 类 号：R473[医药卫生—护理学]