基于奥马哈系统框架的延续护理对高血压脑出血术后病人康复效果影响的系统评价  

Influence of continuous nursing based on Omaha System on rehabilitation of postoperative patients with hypertensive intracerebral hemorrhage:a systematic review

作　　者：周雪迎 张雪芳[2] 冯静宜 蔡文静 ZHOU Xueying;ZHANG Xuefang;FENG Jingyi;CAI Wenjing(School of Nursing,Nanjing University of Traditional Chinese Medicine,Jiangsu 210023 China)

机构地区：[1]南京中医药大学护理学院,江苏210023 [2]南京市中医院

出　　处：《循证护理》2023年第3期394-401,共8页Chinese Evidence-Based Nursing

基　　金：南京市卫生科技发展专项资金项目,编号:YKK19100。

摘　　要：目的:系统评价以奥马哈系统为框架的延续护理应用于高血压脑出血(HICH)术后病人的干预效果。方法:计算机检索中国知网(CNKI)、维普(VIP)、万方数据库(WanFang Database)、中国生物医学文献服务系统(SinoMed)、PubMed、EMbase、the Cochrane Library和Web of Science数据库,收集基于奥马哈系统框架的延续护理对HICH术后病人干预的随机对照试验研究(RCT),检索时限从建库至2022年2月28日。由2位研究者独立对文献进行筛选,采用Cochrane 6.1偏倚风险评估工具对所纳入的文献进行质量评价,应用RevMan 5.4软件对纳入研究进行Meta分析,并采用GRADE系统对结局指标进行证据质量等级评价。结果:纳入13篇研究,共994例HICH术后病人。Meta分析结果显示,与对照组相比,试验组HICH术后病人认知评分[MD=0.68,95%CI(0.60,0.76),P<0.00001]、行为评分[MD=0.81,95%CI(0.72,0.89),P<0.00001]、状态评分[MD=1.11,95%CI(0.82,1.40),P<0.00001]、焦虑评分[MD=-6.99,95%CI(-8.85,-5.13),P<0.00001]、抑郁评分[MD=-8.23,95%CI(-10.56,-5.90),P<0.00001]、Barthel量表评分[MD=8.53,95%CI(2.99,14.07),P=0.003]、功能独立性评定量表(FIM)评分[MD=11.05,95%CI(7.09,15.01),P<0.00001]、生活质量评分[MD=6.64,95%CI(5.04,8.25),P<0.00001]差异有统计学意义(P<0.05)。GRADE结局指标评价显示证据质量为中等到极低级别。结论:基于现有证据,与常规护理相比,基于奥马哈系统框架的延续护理在改善HICH术后病人的认知、行为、状态,降低焦虑、抑郁情绪,增强自理能力,提高其生活质量等方面有一定的优势,由于文献数量和质量的限制,未来还需更高质量的研究进一步论证以奥马哈系统为框架的延续护理应用于HICH术后病人的干预效果。Objective:To systematically evaluate the intervention effect of continuous nursing based on Omaha System on patients with hypertensive intracerebral hemorrhage(HICH)after operation.Methods:Randomized controlled trials(RCTs)on Omaha continuous nursing of the intervention of postoperative patients with HICH were searched from CNKI,VIP,WanFang Database,PubMed,SinoMed,EMbase,the Cochrane Library and Web of Science.The retrieval time was from the establishment of the database to Febrary 28,2022.The articles were screened independently by two researchers.The"Cochrane 6.1 bias risk assessment"tool was used to evaluate the quality of the included literature,Rewiew Manager 5.4 software was used for Meta-analysis,and the GRADE Profiler 3.6 was used to evaluate the quality of the outcome indicators.Results:A total of 994 postoperative patients with HICH were included in 13 studies.Meta-analysis results showed that,compared with control group,the difference of the cognitive score[MD=0.68,95%CI(0.60,0.76),P<0.00001]、the behavior score[MD=0.81,95%CI(0.72,0.89),P<0.00001],the state score[MD=1.11,95%CI(0.82,1.40),P<0.0001],the anxiety score[MD=-6.99,95%CI(-8.85,-5.13),P<0.00001],the depression score[MD=-8.23,95%CI(-10.56,-5.90),P<0.00001],Barthel Scale score[MD=8.53,95%CI(2.99,14.07),P=0.003],function independent measure(FIM)[MD=11.05,95%CI(7.09,15.01),P<0.00001],the score of quality of life[MD=6.64,95%CI(5.04,8.25),P<0.00001]of patients with HICH in the experimental group were statistically significant(P<0.05).GRADE outcome indicator evaluation showed that the quality of evidence was medium to very low.Conclusions:Current evidence shows that compared with conventional nursing,Omaha continuous nursing have positive effects on improving the cognitive function behavior and state level of patients with HICH,reducing anxiety and depression,enhancing patients′self-care ability and their quality of life.Due to the limited quantity and quality of literature,the conclusion need to be further verified by more high-quality studies to

关 键 词：奥马哈系统 延续护理 高血压脑出血 系统评价 GRADE系统 循证护理 

分 类 号：R473.6[医药卫生—护理学]