急性脑卒中患者超早期活动干预安全性和有效性的Meta分析  

Meta-analysis on the safety and efficacy of very early mobilization intervention in patients with acute cerebral stroke

作　　者：徐巩林 李程程 马瑞英[1] Xu Gonglin;Li Chengcheng;Ma Ruiying(School of Nursing,Capital Medical University,Beijing 100069,China;Mingde College,Xinxiang Medical University,Xinxiang 453003,China)

机构地区：[1]首都医科大学护理学院,北京100069 [2]新乡医学院明德书院,新乡453003

出　　处：《中华现代护理杂志》2023年第31期4261-4269,共9页Chinese Journal of Modern Nursing

基　　金：北京市教育委员会科研计划项目资助(SM202010025005)。

摘　　要：目的通过Meta分析评价急性脑卒中患者超早期活动干预的安全性和有效性。方法检索PubMed、Cochrane Library、Embase、中国知网、万方数据库、维普数据库、中国生物医学文献数据库,筛选超早期活动对急性脑卒中患者干预效果和安全性的随机对照试验,检索时限为建库至2023年1月23日。由2名研究人员根据纳入和排除标准筛选文献、提取资料及文献质量评价,采用RevMan 5.3软件进行分析。结果共纳入13篇文献,包括3 202例急性脑卒中患者。Meta分析结果显示,与常规护理方法相比,超早期活动可以有效降低急性脑卒中患者卒中后并发症发生率[RR=0.59,95%CI(0.46,0.75),P<0.001],提高患者的日常生活能力[MD=6.63,95%CI(2.99,10.27),P<0.001],缩短患者住院时间[MD=-2.46,95%CI(-3.86,-1.05),P<0.001];不增加急性脑卒中患者的病死率[RR=1.11,95%CI(0.85,1.45),P>0.05]、不良事件发生率[RR=0.85,95%CI(0.60,1.20),P>0.05]和残疾发生率[RR=0.94,95%CI(0.76,1.15),P>0.05]。对干预措施的开始时间和频率进行亚组分析显示,在24~72 h亚组内,与常规护理相比,超早期活动干预可有效降低急性脑卒中患者病死率,差异有统计学意义(P<0.05);在0~24 h亚组内,两者差异无统计学意义(P>0.05);在每天活动频率≥1次亚组和每天活动频率≥2次亚组内,与常规护理相比,超早期活动干预均可有效提高日常生活能力,差异均有统计学意义(P<0.05)。每天活动频率不确定亚组内,两者差异无统计学意义(P>0.05)。结论超早期活动干预可以安全、有效地降低急性脑卒中患者卒中后并发症发生率,提高日常生活能力,缩短住院时间。Objective To evaluate the safety and efficacy of very early mobilization intervention in patients with acute cerebral stroke through a Meta-analysis.Methods Randomized controlled trials(RCTs)investigating the efficacy and safety of very early mobilization intervention in acute cerebral stroke patients were searched in databases including PubMed,Cochrane Library,Embase,CNKI,Wanfang,VIP and SinoMed up until January 23,2023.Two researchers independently screened the literature,extracted data,and assessed the quality of the included studies based on inclusion and exclusion criteria.Analysis was performed using RevMan 5.3.Results A total of 13 studies involving 3202 acute cerebral stroke patients were included.The Meta-analysis revealed that compared with conventional nursing methods,very early mobilization intervention effectively reduced the incidence of post-stroke complications[RR=0.59,95%CI(0.46,0.75),P<0.001],enhanced patients'daily living abilities[MD=6.63,95%CI(2.99,10.27),P<0.001],and shortened the length of hospital stay[MD=-2.46,95%CI(-3.86,-1.05),P<0.001].The intervention did not increase the rates of mortality[RR=1.11,95%CI(0.85,1.45),P>0.05],adverse events[RR=0.85,95%CI(0.60,1.20),P>0.05],or disability[RR=0.94,95%CI(0.76,1.15),P>0.05]in acute cerebral stroke patients.Subgroup analysis on the initiation time and frequency of the intervention showed a statistically significant reduction in mortality rate in the 24-72 h subgroup(P<0.05),while no significant difference was found in the 0-24 h subgroup(P>0.05).Both subgroups with activity frequencies of≥1 time/day and≥2 times/day showed significant improvements in daily living abilities compared to conventional care(P<0.05),whereas no significant difference was found in the subgroup with uncertain daily activity frequency(P>0.05).Conclusions Very early mobilization intervention can safely and effectively reduce the incidence of post-stroke complications in patients with acute cerebral stroke,improve daily living abilities,and shorten the length of hospita

关 键 词：META分析 脑梗死 康复 急性 超早期活动 

分 类 号：R473.74[医药卫生—护理学]