早期系统性康复活动对ICU机械通气患者肌力及预后影响的Meta分析  

Effect of early systemic rehabilitation on muscle strength and prognosis of patients undergoing mechanical ventilation in intensive care unit:a Meta-analysis

作　　者：王来[1] 张继华[2] 武丽萍[1] 周颖 Wang Lai;Zhang Jihua;Wu Liping;Zhou Ying(Department of Critical Care Medicine,the First Hospital of Hebei Medical University,Shijiazhuang 050031,Hebei,China;Department of Otorhinolaryngology Head and Neck Surgery,the First Hospital of Hebei Medical University,Shijiazhuang 050031,Hebei,China)

机构地区：[1]河北医科大学第一医院重症医学科,石家庄050031 [2]河北医科大学第一医院耳鼻咽喉头颈外科,石家庄050031

出　　处：《中华危重病急救医学》2023年第11期1212-1217,共6页Chinese Critical Care Medicine

基　　金：河北省医学科学研究计划项目(20211701)。

摘　　要：目的系统评价早期系统性康复活动对重症监护病房(ICU)机械通气患者肌力及预后的影响。方法应用计算机检索Cochrane图书馆、美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库、中国知网、维普数据库、万方数据库,从建库至2022年10月公开发表的关于ICU机械通气患者早期系统性康复活动的随机对照试验(RCT)。观察组实施早期系统性康复活动,对照组实施常规活动;结局指标包括英国医学研究委员会肌力评分(MRC评分)、ICU获得性衰弱(ICU-AW)发生率、简明健康调查量表(SF-36)评分、住院时间及病死率等。由2名研究员独立筛选文献、提取资料并评价文献质量,对符合质量标准的研究进行Meta分析;采用漏斗图分析各项研究发表偏倚。结果共纳入14篇文献,其中英文13篇,中文1篇;共涉及1835例患者,其中观察组922例,对照组913例。整体文献质量良好。Meta分析结果显示,与对照组比较,观察组患者ICU-AW发生率明显降低〔相对危险度(RR)=0.78,95%可信区间(95%CI)为0.62~0.98,P<0.05〕,但MRC评分无明显增高〔加权均数差(WMD)=2.51,95%CI为0.77~4.25,P=0.05〕;两组患者ICU病死率(RR=1.05,95%CI为0.59~1.87,P>0.05)、住院病死率(RR=1.15,95%CI为0.76~1.74,P>0.05)、ICU住院时间(WMD=-3.02,95%CI为-7.29~1.24,P>0.05)、总住院时间(WMD=-3.67,95%CI为-8.04~0.70,P>0.05)及出院后6个月SF-36量表中躯体健康评分(PCS;WMD=1.83,95%CI为-0.28~3.93,P>0.05)和心理健康评分(MCS;WMD=1.72,95%CI为-0.76~4.20,P>0.05)差异均无统计学意义。对MRC评分、ICU-AW发生率、病死率、住院时间及SF-36量表评分绘制漏斗图显示,纳入文献的效应点基本呈"倒漏斗"形,且基本对称,提示文献发表偏倚较小。结论早期系统性康复活动能够显著降低ICU机械通气患者ICU-AW发生率,且不增加病死率,但对患者肌力及身体功能无明显改善作用。ObjectiveTo systematically evaluate the effect of early systematic rehabilitation on muscle strength and prognosis of patients undergoing mechanical ventilation in intensive care unit(ICU)MethodsCochrane Library,PubMed,Embase,China National Knowledge Infrastructure(CNKI),VIP database(VIP)and Wanfang database were searched by computer for randomized controlled trial(RCT)on early systematic rehabilitation of patients undergoing mechanical ventilation in ICU published from the establishment of the database to October 2022.The observation group was given early systematic rehabilitation,while the control group was given routine activities.The outcome indicators included Medical Research Council muscle strength score(MRC score),incidence of ICU-acquired weakness(ICU-AW),36-item short form health survey scale(SF-36),length of hospital stay,and hospital mortality.Two researchers independently screened the literature,extracted the data,and evaluated the quality of the literature to conduct a Meta-analysis of the studies that met the quality criteria.Funnel plot was used to analyze the publication bias of each study.ResultsA total of 14 articles were enrolled,13 in English and 1 in Chinese.A total of 1835 patients were involved,including 922 cases in the observation group and 913 cases in the control group.The overall literature quality was good.Compared with the control group,the incidence of ICU-AW in the observation group was significantly reduced[relative risk(RR)=0.78,95%confidence interval(95%CI)was 0.62-0.98,P<0.05],but the MRC score was not significantly increased[weighted mean difference(WMD)=2.51,95%CI was 0.77-4.25,P=0.05].There were no significant differences in ICU mortality(RR=1.05,95%CI=0.59-1.87,P>0.05),hospital mortality(RR=1.15,95%CI was 0.76-1.74,P>0.05),length of ICU stay(WMD=-3.02,95%CI was-7.29-1.24,P>0.05),total length of hospital stay(WMD=-3.67,95%CI was-8.04-0.70,P>0.05),and physical component summary(PCS;WMD=1.83,95%CI was-0.28-3.93,P>0.05)and mental component summary(MCS;WMD=1.72,95%CI was-0.76-4

关 键 词：早期系统性康复活动 ICU获得性衰弱 机械通气 预后 

分 类 号：R459.7[医药卫生—急诊医学]