不同干预措施对经皮冠状动脉介入术后患者运动恐惧干预效果的网状Meta分析  

The effectiveness of different interventions in post-percutaneous coronary intervention patients with kinesiophobia:a network Meta-analysis

作　　者：郝丽丽[1] 马艳秋 张正涛 梁宝凤 法天锷[1] Hao Lili;Ma Yanqiu;Zhang Zhengtao;Liang Baofeng;Fa Tiane(Department of Nursing,Tianjin Chest Hospital,Tianjin 300222,China;Graduate School of Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]天津市胸科医院护理部,天津300222 [2]天津中医药大学研究生院,天津301617

出　　处：《中国实用护理杂志》2024年第20期1542-1549,共8页Chinese Journal of Practical Nursing

基　　金：天津市医学重点学科(专科)建设项目(内科学-心血管病学)(TJYXZDXK-055B)。

摘　　要：目的采用网状Meta分析评价不同干预措施是否能降低经皮冠状动脉介入(PCI)术后患者运动恐惧水平。方法计算机检索万方数据库、中国知网、中国生物医学文献数据库、维普期刊数据库、Webof Science、PubMed、CochraneLibrary、Embase、CINAHL中与PCI术后患者运动恐惧干预措施相关的随机对照试验和类实验研究,检索时限从建库至2023年8月3日。文献筛选、资料提取和文献质量评价均由2名研究者独立进行,采用Stata17.0软件进行网状Meta分析。结果共纳入13篇文献,包括9篇随机对照试验和4篇类实验。网状Meta分析显示,认知行为疗法(SMD=-4.08,95%CI-6.49~-1.67)、认知行为疗法联合心脏康复(SMD=-3.02,95%CI-5.43~-0.61)、双心医疗干预(SMD=-2.48,95%CI-4.87~-0.09)均能降低PCI术后患者运动恐惧水平,与常规护理相比,差异均有统计学意义(均P<0.05)。排序概率图显示,在降低PCI术后患者运动恐惧方面,9种干预措施的干预效果由高到低分别是认知行为疗法、认知行为疗法联合心脏康复、基于适应性领导理论的干预、双心医疗干预、COX健康行为互动模式、基于行为改变轮的健康教育、等级暴露疗法、正念干预、高强度间歇训练。结论认知行为疗法对PCI术后患者运动恐惧的干预效果最佳,但需要更多高质量的随机对照试验进一步验证。Objective To evaluate the effect of different interventions in post-percutaneous coronary intervention(PCI)patients with kinesiophobia using network Meta-analysis.Methods Computerized search of randomized controlled trials and quasi-experiment related to kinesiophobia interventions for post-PCI patients in WanFang database,China National Knowledge Infrastructure,China Biology Medicine,VIP database,Web of Science,PubMed,Cochrane Library and Embase was conducted with a time frame of searching from the establishment of the library to August 3,2023.Literature screening,data extraction and literature quality evaluation were carried out independently by two researchers.Network Meta-analysis was performed using Stata 17.0 software.Results A total of 13 literatures were included,including 9 randomized controlled trials and 4 quasi-experiments.Network Metaanalysis showed that cognitive behavioral therapy(SMD=-4.08,95%CI-6.49-1.67),cognitive behavioral therapy combined with cardiac rehabilitation(SMD=-3.02,95%CI-5.43-0.61),dual heart medical intervention(SMD=-2.48,95%,-4.87-0.09)can reduce the level of exercise fear in patients after PCI,and the difference were statistically significant compared with routine nursing(all P<0.05).Ranked probability plots showed that the effects of the nine interventions in reducing kinesiophobia in post-PCI patients were cognitive behavioral therapy,cognitive behavioral therapy combined with cardiac rehabilitation,adaptive leadership theory-based intervention,dual heart medical intervention,COX health behavior interaction model,health education based on the behavioral change wheel,graded exposure therapy,mindfulness intervention,and high-intensity interval training in descending order of effectiveness.Conclusions Cognitive behavioral therapy was the most effective intervention for kinesiophobia in post-PCI patients,but more high-quality randomized controlled trials are needed to further verify this conclusion.

关 键 词：经皮冠状动脉介入术 运动恐惧 网状Meta分析 

分 类 号：R473.5[医药卫生—护理学]