重症监护病房机械通气患者早期活动有效性与安全性的Meta分析  

Effectiveness and safety of early mobilization for patients with mechanical ventilation in ICU:a meta-analysis

作　　者：李鑫 王玉梅[2] 熊莉娟 黄海燕[3] Li Xin;Wang Yumei;Xiong Lijuan;Huang Haiyan(Nursing Department;Geriatric Department;ICU,Union Hospital,Tongji Medical School,Huazhong University of Science and Technology,Wuhan,430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院护理部,湖北武汉430022 [2]华中科技大学同济医学院附属协和医院综合科,湖北武汉430022 [3]华中科技大学同济医学院附属协和医院ICU,湖北武汉430022

出　　处：《现代临床护理》2018年第10期34-41,共8页Modern Clinical Nursing

基　　金：中华护理学会2017年-2018年度立项科研项目;项目编号为ZHKY201703

摘　　要：目的评价早期活动对重症监护病房(intensive care unit,ICU)机械通气患者有效性及安全性的影响,为护理人员临床决策提供参考。方法应用计算机检索Cochrane library、CINAHL、PubMed、EMBASE、CNKI、CBM、万方等数据库有关ICU机械通气患者早期活动的随机对照试验,经逐层筛选文献质量评价后,应用RevMan5.3软件进行Meta分析。结果共纳入12篇随机对照试验研究,涉及1303例研究对象。Meta分析结果显示,相比于常规护理措施,ICU机械通气患者早期活动能缩短机械通气时间[MD=-3.86,95%CI(-6.20,-1.52),P=0.001];缩短ICU住院时间[MD=-4.20,95%CI(-7.56,-0.83),P=0.01];缩短总住院时间[MD=-5.25,95%CI(-9.13,-1.37),P=0.008];缩短首次离床时间[MD=-8.72,95%CI=(-13.42,-4.02),P<0.001]等;降低呼吸机相关性肺炎(ventilator associated pneumonia,VAP)发生率[OR=0.28,95%CI (0.14,0.53),P<0.001]。结论早期活动对ICU机械通气患者安全有效,不仅能缩短机械通气时间、ICU住院时间与总住院时间,对降低VAP发生率也具有有效作用,可以应用于临床。bjective To evaluate the effectiveness and safety of early mobilization for patients with mechanical ventilation in ICU by meta analysis. Methods The randomized controlled trials （RCTs） on the effects of mechanically-ventilated patients in ICU were retrieved through Cochrane library, CINAHL, PubMed, EMBASE, CNKI, CBM and Wanfang Database. The acquired data were evaluated in view of the quality, followed by meta-analysis using Rev Man 5.3 software. Results Totally 12 papers on RCTs were included, involving 1,303 participants. By mata-analysis, early mobilization shortened the duration of mechanical ventilation [MD=-3.86, 95%CI （-6.20, -1.52）, P=0.001], length of stay in ICU [MD=-4.20, 95%CI （-7.56, -0.83）, P=0.01], length of stay [MD=-5.25, 95%CI （-9.13, -1.37）, P=0.008], and days to first out of bed [MD=-8.72, 95%CI=（-13.42, -4.02）, P〈0.001], reduced mortality and incidence of VAP [OR=0.90, 95%CI=（0.62, 1.31）, P=0.58; OR=0.28; 95%CI=（0.14, 0.53, P〈0.001]. Conclusions Early mobilization is effective and safe for patients with mechanical ventilation. It can not only reduce the time of mechanical ventilation and the length of stay in ICU and hospital, but also reduce the mortality and incidence of VAP. Therefore, it can be used in clinical application.

关 键 词：重症监护病房 机械通气 早期活动 META分析 

分 类 号：R47[医药卫生—护理学]