早期康复对重症病人生活质量影响的Meta分析  

Impact of early rehabilitation on quality of life in critically ill patients:a Meta-analysis

作　　者：唐光明 杨娜 雷云宏[1] 刘静兰[1] 刘琼[1] 胡海燕[1] 陈敏敏[1] 姚青[1] 王妮[1] 陈琛琛[1] 田飞 胡传军 李子锋 肖文武 刘玲[1] TANG Guangming;YANG Na;LEI Yunhong;LIU Jinglan;LIU Qiong;HU Haiyan;CHEN Minmin;YAO Qing;WANG Ni;CHEN Chenchen;TIAN Fei;HU Chuanjun;LI Zifeng;XIAO Wenwu;LIU Ling(The First College of Clinical Medical Science,Three Gorges University,Hubei 443003 China)

机构地区：[1]三峡大学第一临床医学院(湖北省宜昌市中心人民医院),443003

出　　处：《循证护理》2020年第9期869-877,共9页Chinese Evidence-Based Nursing

基　　金：宜昌市软科学研究计划项目.编号:A18-30310。

摘　　要：[目的]系统评估早期康复对重症病人生活质量的影响。[方法]通过计算机检索中国知网、万方数据库、维普中文科技期刊全文数据库、PubMed、the Cochrane Library,研究类型关于重症病人早期康复干预的随机对照试验或队列研究。检索时间为建库至2019年6月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。[结果]纳入16篇随机对照研究,共1433例病人。Meta分析结果显示:与对照组相比,试验组早期康复干预可改善重症病人肌力(MRC-score)情况[MD=7.02,95%CI(5.96,8.09),P<0.00001]、提升重症病人日常生活能力[SMD=1.24,95%CI(0.85,1.63),P<0.00001]、减少ICU-AW发生率[OR=0.38,95%CI(0.16,0.89),P=0.03]、缩短机械通气时间[SMD=-1.78,95%CI(-2.49,-1.07),P<0.00001]和ICU住院时间[SMD=-1.23,95%CI(-1.73,-0.74),P<0.00001]。[结论]现有证据表明,早期康复干预可改善重症病人肌力(MRC-score),提升重症病人日常生活能力,减少ICU-AW发生率,缩短机械通气时间和ICU住院时间。但受纳入研究质量和数量的限制,上述结论有待更大样本量、多中心、高质量的研究验证。Objective:To systematically assess the impact of early rehabilitation on the quality of life(QOL)of critically ill patients.Methods:Randomized controlled trials(RCTs)or cohort study on early rehabilitation intervention in critically ill patients were retrieved from following databases,the Chinese National Knowledge Infrastructure(CNKI),WanFang Database,VIP Chinese Science and Technology Journal Full-text Database,PubMed,and the Cochrane Library.The retrieval time was from databases establishment to June 2019.Screening of the literature,extraction of the data,and evaluation of bias risks of included studies were performed by two researchers independently Meta-analysis was performed using Results:Sixteen randomized controlled studies were included,involving 1433 patients.Meta-analysis results showed that compared with the control group,early rehabilitation intervention in the experimental group could improve the critically ill patients’Medical Research Council score(MRC-score)[MD=7.02,95%CI(5.96,8.09),P<0.00001],strengthen the ability of daily living[SMD=1.24,95%CI(0.85,1.63),P<0.00001],reduce the incidence of intensive care unit acquired weakness(ICU-AW)[OR=0.38,95%CI(0.16,0.84),P=0.03],shorten mechanical ventilation time[SMD=-1.78,95%CI(-2.49,-1.07),P<0.00001]and decreased length of stay in ICU[SMD=-1.23,95%CI(-1.73,-0.74),P<0.00001].Conclusions:The existing evidence shows that early rehabilitation intervention could improve the MRC-score of critically ill patients,strengthen their daily living ability,reduce the incidence of ICU-AW,and shorten the time of mechanical ventilation and length of stay in ICU.However,limited by the quality and quantity of the included studies,the above conclusions need to be verified by larger sample size,multiple centers,and high-quality studies.

关 键 词：早期康复 重症病人 生活质量 META分析 获得性衰弱 肌力 自理能力 

分 类 号：R47[医药卫生—护理学]