曲线仰卧位预防压力性损伤发生的Meta分析  

Curved supine position on the prevention of pressure injury:a Meta-analysis

作　　者：陈静[1] 刘海微 胡蓉[1] CHEN Jing;LIU Haiwei;HU Rong(Xiangya Hospital Central South University,Hunan 410008 China)

机构地区：[1]中南大学湘雅医院,湖南410008

出　　处：《循证护理》2023年第15期2661-2669,共9页Chinese Evidence-Based Nursing

摘　　要：目的:评价曲线仰卧位预防压力性损伤的效果。方法:计算机检索中国生物医学文献数据库、维普数据库、万方数据库、中国知网、EMbase、PubMed、Web of Science和the Cochrance Library关于曲线仰卧位对病人压力性损伤预防效果干预的随机对照试验(RCT)。检索时限为各数据库建库至2022年12月16日。对符合质量标准的文献采用RevMan 5.3软件进行Meta分析。结果:共纳入14篇文献,涉及2338例病人。Meta分析结果显示曲线仰卧位可降低压力性损伤发生率[OR=0.14,95%CI(0.09,0.23),P<0.00001]、Ⅰ期压力性损伤发生率[OR=0.18,95%CI(0.10,0.33),P<0.00001]、Ⅱ期压力性损伤发生率[OR=0.23,95%CI(0.09,0.60),P=0.003]及Ⅲ期压力性损伤发生率[OR=0.23,95%CI(0.06,0.92),P=0.04],但是无法确定Ⅳ压力性损伤发生率的效果[OR=0.33,95%CI(0.01,8.21),P=0.50];能有效降低骶尾部压力[WMD=-2.89,95%CI(-3.83,-1.96),P<0.00001]、枕部压力[WMD=-2.13,95%CI(-3.78,-0.49),P=0.01]、足跟部压力[WMD=-11.02,95%CI(-16.42,-5.63),P<0.00001],会增加小腿压力[WMD=3.44,95%CI(0.95,5.93),P=0.007]。但对肩胛部压力无统计学意义。根据Braden压力性损伤风险量表评分效果分析发现曲线仰卧位可提高潮湿程度评分[WMD=0.39,95%CI(0.21,0.56),P<0.0001]、活动能力评分[WMD=0.45,95%CI(0.04,0.86),P=0.03]、移动能力评分[WMD=0.55,95%CI(0.42,0.67),P<0.00001]、营养摄取能力评分[WMD=0.44,95%CI(0.09,0.79),P=0.01]、摩擦/剪切力评分[WMD=0.53,95%CI(0.40,0.66),P<0.00001],但是无法确定感知能力评分的影响[WMD=0.28,95%CI(-0.20,0.77),P=0.25]。结论:现有证据证明,曲线仰卧位对预防压力性损伤具有一定效果,还需进行大样本研究。Objective:To evaluate the effect of curved supine position in the prevention of pressure injury.Methods:Randomized controlled trials(RCTs)of the effect of curved supine position on the prevention of pressure injury intervention in patients were retrieved from CBM,VIP,WanFang Database,CNKI,EMbase,PubMed,Web of Science and the Cochrance Library.The retrieval time was from the inception to December 16,2022.The literature that met the quality criteria was subjected to RevMan 5.3 software Meta-analysis was performed.Results:A total of 14 articles were included,involving 2338 patients.Meta-analysis results showed that the curved supine position reduced the incidence of pressure ulcers(OR=0.14,95%CI 0.09-0.23,P<0.00001),stage I pressure ulcers(OR=0.18,95%CI 0.10-0.33,P<0.00001),stageⅡpressure ulcer incidence(OR=0.23,95%CI 0.09-0.60,P=0.003),and stageⅢpressure ulcer incidence(OR=0.23,95%CI 0.06-0.92,P=0.04),but the effect ofⅣpressure ulcer incidence could not be determined(OR=0.33,95%CI 0.01-8.21,P=0.50);it was effective in reducing sacrococcygeal pressure(WMD=-2.89,95%CI-3.83--1.96,P<0.00001),occipital pressure(WMD=-2.13,95%CI-3.78--0.49,P=0.01),and heel pressure(WMD=-11.02,95%CI-16.42--5.63,P<0.00001),but increases calf pressure(WMD=3.44,95%CI 0.95-5.93,P=0.007),but the scapular pressure was no statistically significant.According to the Braden Pressure Sore Risk Scale score effect analysis found that the curved supine position improved the wetness score(WMD=0.39,95%CI 0.21-0.56,P<0.0001),mobility score(WMD=0.45,95%CI 0.04-0.86,P=0.03),and mobility score(WMD=0.55,95%CI 0.42-0.67,P<0.00001),nutrient uptake capacity score(WMD=0.44,95%CI 0.09-0.79,P=0.01),and friction/shear force score(WMD=0.53,95%CI 0.40-0.66,P<0.00001),but the effect of perceptual capacity score could not be determined(WMD=0.28,95%CI 0.20-0.77,P=0.25).Conclusion:The current evidence shows that curved supine position is effective in preventing stress injuries,and a large sample needs to be studied.

关 键 词：曲线仰卧位 压力性损伤 压疮 护理 META分析 循证护理 

分 类 号：R473.6[医药卫生—护理学]