正念疗法对肠造口患者病耻感的Meta分析和GRADE证据级别评价  

Meta analysis and DRADE evaluation of effects of mindfulness therapy on stigma among patients with ostomy

作　　者：王珑[1] 梁小琴[1] 王历刚 徐鉥 张曦 Wang Long;Liang Xiaoqin;Wang Ligang;Xu Su;Zhang Xi(Department of Gastrointestinal Surgery,Fujian Provincial Hospital,Fuzhou,Fujian 350001,China;School of Nursing,Fujian University of TCM,Fuzhou,Fujian 350001,China)

机构地区：[1]福建省立医院胃肠外科,福建福州350001 [2]福建中医药大学护理学院

出　　处：《齐齐哈尔医学院学报》2023年第19期1877-1882,共6页Journal of Qiqihar Medical University

基　　金：福建医科大学教育教学改革研究项目(202010393006);福建医科大学启航基金(2020QH1146)。

摘　　要：目的系统评价正念疗法对肠造口患者病耻感的干预效果。方法计算机检索中国知网、维普、万方、中国生物医学文献数据库、PubMed、Cochrane libarary、Web of Science、Embase、EBSCOhost和JAMA美国医学会等10个电子数据库,各中英文电子数据库建库至2022年9月10日收录的正念疗法对肠造口患者病耻感的随机对照试验研究(RCTs),采用Cochrane偏倚风险评估表进行偏倚风险评估、Rev Man 5.4软件进行Meta分析和GRADE系统对结局指标进行质量等级评价。结果共纳入6项符合纳入标准的RCTs,共609例患者,纳入研究方法学整体质量较低,Meta分析结果显示,正念疗法都能有效降低肠造口患者社会影响量表评分[MD=-10.24,95%CI(-16.43,-4.05),P=0.001]、社会排斥评分[MD=-4.40,95%CI(-5.59,-3.21),P<0.00001]、社会隔离评分[MD=-2.92,95%CI(-4.06,-1.78),P<0.00001]、经济歧视评分[MD=-1.62,95%CI(-2.75,-0.50),P=0.005]、内在羞耻感评分[MD=-2.51,95%CI(-3.90,-1.12),P=0.0004];GRADE证据质量评级显示纳入研究结局指标均被评为极低级质量。结论正念疗法在减轻肠造口患者病耻感具有积极的作用效果,在提升患者生活质量方面未来的研究还需要大样本、多中心的高质量随机对照研究提供有力的证据支持。Objective To systematically evaluate the intervention effect of mindfulness therapy on the stigma among patients underwent ostomy.Methods Randomized controlled trial study(RCTs)on mindfulness therapy for Stigma among patients underwent enterostomy were searched from the CNKI,VIP,Wanfang,CBM,PubMed,Cochrane libarary,Web of science,Embase,EBSCOhost,and JAMA.The time range was from the establish of the database till September 10,2022.Cochrane collaborations tool forassessing risk of bias was used to evaluate the methodological quality.Meta analysis was conducted with RevMan 5.4 software and evidence quality evaluation was conducted by GRADE standards.Results There were 6 RCTs and 609 patients underwent ostomy eligible for the inclusion criteria were enrolled in the study.The results of methodological quality evaluation are of low quality.Meta-analysis showed that mindfulness therapy can effectively reduce scores of social impact scale[MD=-10.24,95%CI(-16.43,-4.05),P=0.001],social rejection[MD=-4.40,95%CI(-5.59,-3.21),P<0.00001],social isolation[MD=-2.92,95%CI(-4.06,-1.78),P<0.00001],financial insecurity[MD=-1.62,95%CI(-2.75,-0.50),P=0.005],and internalized shame[MD=-2.51,95%CI(-3.90,-1.12),P=0.0004]of underwent ostomy.The GRADE evidence quality rating showed that the outcome indicators of the included studies were rated as very low quality.Conclusions Mindfulness therapy can effectively reduce stigma of patient underwent ostomy.In terms of improving the quality of life of patients,future research also needs strong evidence support from large sample,multi center,high-quality randomized controlled studies.

关 键 词：正念疗法 肠造口 病耻感 META分析 GRADE评价 

分 类 号：R473.6[医药卫生—护理学]