集束化护理预防呼吸机相关性肺炎的meta分析  

Efficacy of bundles of care to prevent ventilator associated pneumonia:a meta-analysis

作　　者：何立敏[1,2] 凌舒娅 谢莉玲[3] 

机构地区：[1]重庆医科大学附属第一医院第一分院心内科,重庆400015 [2]重庆医科大学公共卫生与管理学院生殖生物学研究室,重庆400016 [3]重庆医科大学附属第一医院第一分院护理部,重庆400015

出　　处：《现代医药卫生》2017年第14期2113-2116,共4页Journal of Modern Medicine & Health

摘　　要：目的评价集束化护理对呼吸机相关性肺炎(VAP)的有效性。方法采用计算机检索Pubmed、Embase、the Cochrane Library、CNKI、万方、维普等数据库有关集束化护理与VAP的研究,检索日期截至2016年7月1日。2位作者独立提取数据及文献质量评价。应用Rev Man 5.2进行数据统计分析。结果共纳入29篇文献,9 271例患者,其中集束化护理组4 600例,常规护理组4 671例。通过集束化护理可明显减少VAP的发生[相对危险度(RR)=0.59,95%CI(0.54,0.65)],明显缩短机械通气时间[加权均数差(WMD)=-5.03 d,95%CI(-6.46,-3.60)]及重症监护病房住院时间[WMD=-6.33 d,95%CI(-9.21,-3.44)],且同时可降低患者死亡率[RR=0.68,95%CI(0.58,0.79)],与常规护理组比较,差异均有统计学意义(P<0.01)。结论集束化护理能够有效地预防VAP的发生,明显地缩短机械通气及住院时间,降低患者死亡率,但其安全性尚需进一步研究证实。Objective To evaluate the effectiveness of bundles of care for ventilator-associated pneumonia（VAP）.Methods We searched researches regarding bundles of care for VAP in Pubmed,Embase,the Cochrane Library,CNKI,Wanfang database and VIP database through July 1,2016. Two authors independently extracted data and document quality evaluation.Rev Man 5.2 was applied for statistical analysis. Results Twenty-nine studies（9 271 enrolled patients,including bundles of care group 4 600 patients,4 671 patients in normal care group） were selected for this meta-analysis. The incidence of VAP was reduced significantly by bundles of care [RR =0.59,95% CI（0.54,0.65）],duration of mechanical ventilation was significantly shorter [WMD =-5.03 d,95% CI（-6.46,-3.60）],but will also shorten ICU length of stay [WMD =-6.33 d,95% CI（-9.21,-3.44）] and reduced patient mortality [RR=0.68,95%CI（0.58,0.79）]. Compared with the normal care group,the differenes were not statistically significant（P〈0.05）. Conclusion The bundles of care can effectively prevent ventilator-associated pneumonia,a significant shortening of mechanical ventilation and ICU length of stay and reduce patient mortality,but its safety needs further studies.

关 键 词：肺炎 呼吸机相关性 集束化护理 META分析 护理工作 

分 类 号：R563.1[医药卫生—呼吸系统]