非手术干预对阻塞性睡眠呼吸暂停病人血压影响的网状Meta分析  

Effect of non-surgical intervention on blood pressure in patients with obstructive sleep apnea:a network Meta-analysis

作　　者：韩翠华 陈丽霞 陈思涵 李建华[1] 郭宁 徐璐 马莲莉 卫来[1] 张琦 梁燕[1] 纪代红[1] HAN Cuihua;CHEN Lixia;CHEN Sihan;LI Jianhua;GUO Ning;XU Lu;MA Lianli;WEI Lai;ZHANG Qi;LIANG Yan;JI Daihong(Affiliated Zhongshan Hospital of Dalian University,Liaoning 116001 China)

机构地区：[1]大连大学附属中山医院,辽宁116001 [2]大连大学护理学院

出　　处：《循证护理》2023年第4期586-593,共8页Chinese Evidence-Based Nursing

基　　金：中华医学会资助课题,编号:CMAPH-NRI2019024。

摘　　要：目的:使用贝叶斯网络Meta分析方法评价非手术干预措施对阻塞性睡眠呼吸暂停(OSA)病人血压的影响。方法:系统检索PubMed、the Cochrane Library、EMbase、Web of Science、中国生物医学文献数据库(CBM)、中国知网、万方数据库7个中英文数据库,检索自建库至2021年12月31日所有关于非手术干预措施对OSA病人血压影响的随机对照试验。使用Cochrane风险评估量表对纳入文献进行质量评价,应用Stata15.0进行网状关系图形绘制,Gemtc13.4进行统计分析。结果:共纳入文献19篇,涉及7种单项干预措施、1种联合干预措施和安慰对照。网状Meta分析结果显示,在降低舒张压方面,生活方式+持续气道正压通气>持续气道正压通气>下颌推进装置>安慰对照>口腔矫正器=针灸>吸气肌锻炼>体位保持器>减肥疗法,持续气道正压通气相比体位保持器组和安慰对照组对降低舒张压效果较好,差异有统计学意义(P<0.05)。在降低收缩压方面,体位保持器>生活方式+持续气道正压通气>持续气道正压通气>下颌推进装置>安慰对照>口腔矫正器>针灸>减肥疗法>气道肌肉锻炼。体位保持器较安慰对照效果好,差异有统计学意义(P<0.05),其他干预措施之间差异无统计学意义。结论:现有证据表明,持续气道正压通气呼吸模式单独干预或联合生活方式干预对降低OSA病人舒张压和收缩压的效果较稳定。Objective:To evaluate the effect of non-surgical interventions on blood pressure in patients with obstructive sleep apnea(OSA)using Bayesian network Meta-analysis.Methods:Seven Chinese-English databases including PubMed,the Cochrane Library,EMbase,Web of Science,CBM,CNKI and WanFang Database were systematically searched,and all randomized controlled trials on the effects of non-surgical interventions on blood pressure of OSA patients from the establishment of the database to December 31,2021 were searched.The Cochrane Risk Assessment Scale was used to evaluate the quality of the included documents,Stata15.0 was used to draw the network graph,and Gemtc 13.4 was used for statistical analysis.Results:A total of 19 articles were included,involving 7 individual interventions,1 combined intervention and placebo control.Network Meta-analysis results showed that in terms of reducing diastolic blood pressure,lifestyle+continuous positive airway pressure ventilation>continuous positive airway pressure ventilation>mandibular propulsion device>comfort control>oral appliances=acupuncture>inspiratory muscle training>posture maintainer>weight loss therapy.Compared with the posture maintainer group and the comfort control group,continuous positive airway pressure ventilation had a better effect on reducing diastolic blood pressure,and the difference was statistically significant(P<0.05).In terms of reducing systolic blood pressure,posture maintainer>lifestyle+continuous positive airway pressure ventilation>continuous positive airway pressure ventilation>mandibular propulsion device>comfort control>oral appliances>acupuncture>weight loss therapy>inspiratory muscle training.The effect of posture maintainer was better than that of the placebo control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference between other interventions.Conclusion:Current evidenle shows that the effect of continuous positive airway pressure breathing mode intervention alone or combined with lifes

关 键 词：睡眠呼吸暂停 阻塞性 非手术干预 网状Meta分析 血压 循证护理 

分 类 号：R473.76[医药卫生—护理学]