振动正压通气训练对胸部及上腹部手术患者干预效果的Meta分析  

Meta analysis of the intervention effect of oscillatory positive expiratory pressure training on patients undergoing thoracic and upper abdominal surgery

作　　者：侯晓洁 傅荣[1] 高莉[1] 孙晶娜 王怡欣 牛倩霞 HOU Xiaojie;FU Rong;GAO Li;SUN Jingna;WANG Yixin;NIU Qianxia(Nanjin Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China;Medical School of Nanjing University,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京大学医学院附属鼓楼医院,江苏南京210008 [2]南京大学医学院,江苏南京210008

出　　处：《护士进修杂志》2022年第7期591-599,共9页Journal of Nurses Training

摘　　要：目的 探讨振动正压通气训练在胸部及上腹部术后快速康复中的应用效果,以期为临床康复护理提供循证依据。方法 计算机检索Cochrane Central Register of Controlled Trials(Wiley)、PubMed(MEDLINE)、Web of Science、Embase(OVID)、CBM(SinoMed)、百度学术、中国期刊全文数据库(CNKI)、万方数据库(Wanfang Data)和维普数据库(VIP)数据库,搜集有关振动正压通气训练对胸部及上腹部术后患者干预的随机对照试验(RCT),由2名研究人员独立根据纳排标准进行文献筛选,质量评价和资料提取,应用RevMan 5.0软件进行Meta分析,采用GRADE证据质量分级系统对结局指标的证据质量进行评价。结果 12篇研究符合纳入标准,共1 079例患者。Meta分析结果:振动正压通气训练组与常规康复训练组在1 s用力呼气容积(FEV;)、用力肺活量(FVC)、住院时长、胸管引流量方面比较,差异均有统计学意义(P<0.05),在FEV;/FVC、胸管引流时长、动脉血氧分压[P(O_(2))]、白细胞、抗生素治疗时长方面比较,差异无统计学意义(P>0.05)。GRADE评价显示证据级别为低或极低。结论 振动正压通气训练与传统术后康复相比,在促进胸部及上腹部术后快速康复方面有一定效果,可有效提高患者术后FEV;和FVC,缩短住院时长,但可增加术后胸管引流量,且对FEV;/FVC、胸管引流时长、P(O_(2))、白细胞、抗生素治疗时长方面的应用有效性证据尚不充足。该研究获得证据级别低,结论可靠程度一般,未来需开展更多设计严谨的高质量研究。Objective To explore the application effect of oscillatory positive expiratory pressure training in rapid rehabilitation after thoracic and upper abdominal surgery, so as to provide evidence-based basis for clinical rehabilitation nursing. Methods The databases of Cochrane Central Register of Controlled Trials(Wiley),PubMed(MEDLINE),Web of Science, Embase(OVID),CBM(SinoMed),Baidu academic, China National Knowledge Infrastructure(CNKI), Wanfang Data, and VIP data were searched by computer to collect the randomized controlled trials(RCTs) about the effect of oscillatory positive expiratory pressure training on patients after thoracic and upper abdominal surgery. Two researchers independently conducted literature screening, quality evaluation, and data extraction according to inclusion and exclusion criteria.Meta analysis was performed by Revman 5.0 software. GRADE evidence quality grading system was used to evaluate the evidence quality of outcome indicators.Results Tweleve studies, involving 1 079 patients, met the inclusion criteria. Meta analysis results showed that there were significant differences in 1 s forced expiratory volume(FEV;),forced vital capacity(FVC),length of stay, and quantity of thoracic drainage between the positive vibration pressure ventilation training group and the conventional rehabilitation training group(P<0.05);FEV;/FVC, duration of thoracic drainage, arterial partial pressure of oxygen[P(O_(2))], white blood cell count and duration of antibiotic treatment had no significant difference(P>0.05).GRADE evaluation indicated that the level of evidence was low or very low. Conclusion Compared with the traditional postoperative rehabilitation, oscillatory positive expiratory pressure training has a certain effect in promoting the rapid rehabilitation of patients after thoracic and upper abdominal surgery, which can effectively improve the postoperative FEV;and FVC, shorten the length of hospital stay, but increase the postoperative quantity of thoracic drainage, and the evidence of the effecti

关 键 词：胸部手术 上腹部手术 振动正压通气 快速康复 META分析 

分 类 号：R473.56[医药卫生—护理学] R473.6[医药卫生—临床医学]