医院-社区-家庭延续护理对慢阻肺出院患者肺康复效果的Meta分析  

Meta-analysis on the effect of hospital-community-family continuum of care on pulmonary rehabilitation for patients with chronic obstructive pulmonary disease after discharge

作　　者：黄彩妹[1] 陆柳雪[2] 罗梅银[1] 马丽雅[1] 邓惠英[1] HUANG Caimei;LU Liuxue;LUO Meiyin;MA Liya;DENG Huiying(Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Youjiang Medical University for Nationalities,BaiSe 533000,GuangXi,China;Department of Nursing,The Affiliated Hospital of Youjiang Medical University for Nationalities,BaiSe 533000,GuangXi,China)

机构地区：[1]右江民族医学院附属医院呼吸与危重症医学科,广西百色533000 [2]右江民族医学院附属医院护理部,广西百色533000

出　　处：《右江民族医学院学报》2024年第5期751-759,共9页Journal of Youjiang Medical University for Nationalities

基　　金：广西自然科学基金项目(2020GXNSFAA259038);广西医疗卫生适宜技术开发与推广应用项目(S2021006);广西医疗卫生适宜技术开发与推广应用项目(S2019016)。

摘　　要：目的通过Meta分析评价医院-社区-家庭延续护理对慢阻肺患者出院后的康复效果。方法系统检索中国知网、万方、维普、中国生物医学文献数据库、Web of Science、The Cochrane Library、PubMed、CINAHI、EMbase共9个数据库公开发表的医院-社区-家庭延续护理模式对慢阻肺出院患者肺康复影响的随机对照研究,检索时间为建库至2023年12月31日,采用RevMan5.3软件进行Meta分析。结果纳入23篇文献,Meta分析结果显示:与医院主导的常规延续性护理相比,医院-社区-家庭延续护理模式能较好改善患者肺功能及呼吸困难症状,第1秒用力呼吸量(FEV1)[MD=0.51,95%CI(0.32,0.71),P<0.01]、第1秒用力呼吸量占预计值百分比(FEV1%)[MD=4.52,95%CI(3.13,5.19),P<0.01]、第1秒用力呼吸量与用力肺活量的比值(FEV1/FVC)[MD=8.34,95%CI(5.39,11.30),P<0.01]、改良版呼吸困难量表(mMRC)得分[MD=-0.39,95%CI(-0.52,-0.26),P<0.01];有效提高患者运动耐量[MD=45.23,95%CI(22.33,68.12),P<0.01];显著提高患者生存质量[MD=-4.48,95%CI(-5.46,-3.50),P<0.01]及降低再入院率[MD=0.28,95%CI(0.19,0.43),P<0.01]。结论医院-社区-家庭延续护理模式能有效改善慢阻肺出院患者肺功能和呼吸困难症状,提高患者运动耐量和生存质量,降低再住院率。Objective To evaluate the effect of the hospital-community-family continuum of care model on pulmonary rehabilitation among patients with chronic obstructive pulmonary disease(COPD)after discharge through a meta-analysis.Methods A systematic search was conducted across nine databases(CNKI,Wanfang,VIP,SinoMed,Web of Science,The Cochrane Library,PubMed,CINAHL,and EMbase)to retrieve randomized controlled trials published on the impact of the hospital-community-family continuum of care model on pulmonary rehabilitation for patients with COPD after discharge.The search period was from the inception of the databases to December 31,2023,Meta-analysis was performed using RevMan 5.3 software.Results A total of 23 papers were included.The Meta-analysis results showed that,compared with hospital-led usual continuity of care,the hospital-community-family continuum of care model can better improve the patients’lung function and dyspnea symptoms,the Forced Expiratory Volume in One Second(FEV1)[MD=0.51,95%CI(0.32,0.71),P<0.01],percentage of predicted FEV1(FEV1%)[MD=4.52,95%CI(3.13,5.19),P<0.01],FEV1/FVC ratio[MD=8.34,95%CI(5.39,11.30),P<0.01],and the modified Medical Research Council(mMRC)dyspnea scale score[MD=-0.39,95%CI(-0.52,-0.26),P<0.01].It also significantly improved patients’exercise tolerance[MD=45.23,95%CI(22.33,68.12),P<0.01],quality of life[MD=-4.48,95%CI(-5.46,-3.50),P<0.01]and reduced rehospitalization rates[MD=0.28,95%CI(0.19,0.43),P<0.01].Conclusion The hospital-community-family continuum of care model effectively improves lung function and dyspnea symptoms,enhances exercise tolerance and quality of life,and reduces rehospitalization rates among discharged patients with COPD.

关 键 词：肺疾病 慢性阻塞性 医院-社区-家庭延续护理 肺康复 生存质量 再住院率 

分 类 号：R563.9[医药卫生—呼吸系统]