延续护理对脑卒中吞咽障碍患者应用效果的Meta分析

Efficacy of Transitional Care for Post-Stroke Patient with Dysphagia: A Meta-Analysis

摘要: 目的：该文旨在评价延续性护理干预在脑卒中吞咽障碍患者中的应用效果。方法：计算机检索PubMed、Web of Science、EMBASE、Cochrane Library、中国期刊全文数据库(CNKI)、万方数据库等数据库有关延续性护理干预应用于脑卒中吞咽障碍患者的随机对照试验，采用Cochrane风险偏倚评估工具对文献质量进行评价，应用RevMan5.3对纳入文献进行Meta分析。结果：最终纳入10项研究，共1004名研究对象；Meta分析结果显示，延续性护理干预组在改善脑卒中吞咽障碍患者的吞咽功能恢复上[OR = 3.39, 95%CI: 2.75~5.63, P < 0.00001]、降低吸入性肺炎发生率[OR = 0.15, 95%CI: 0.05~0.49, P = 0.002]、误吸发生率[OR = 0.15, 95%CI: 0.07~0.32, P < 0.00001]、呛咳发生率[OR = 0.09, 95%CI: 0.04~0.20, P < 0.00001]、Barthel指数评分[MD = 5.25, 95%CI: 3.17~7.33, P < 0.00001]、ESCA评分[MD = 9.45, 95%CI: 8.17~10.74, P < 0.00001]方面优于对照组。结论：延续性护理干预能显著地促进脑卒中吞咽障碍患者吞咽功能的恢复，降低并发症发生率，提高患者日常生活能力和自理能力。

Abstract: Objective: To evaluate the effect of transitional care in patients with dysphagia after stroke. Methods: Databases like PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, Wanfang database were searched to random controlled trials (RCT) on continuity of care for post-stroke patients with dysphagia. The Cochrane risk bias assessment tool should be used to evaluate the quality of the included trials. Data was extracted and conducted by RevMan5.3. Results: Ultimately 10 articles and 1004 cases were included. Meta-analysis revealed that the clinical efficacy of transitional care group was superior to the control group in terms of swallowing function recovery [OR = 3.39, 95%CI: 2.75~5.63, P < 0.00001], the incidence rate of aspiration pneumonia [OR = 0.15, 95%CI: 0.05~0.49, P = 0.002], the incidence rate of aspiration [OR = 0.15, 95%CI: 0.07~0.32, P < 0.00001], the incidence rate of cough [OR = 0.09, 95%CI: 0.04~0.20, P < 0.00001], Barthel index scores [MD = 5.25, 95%CI: 3.17~7.33, P < 0.00001], and ESCA scores [MD = 9.45, 95%CI: 8.17~10.74, P < 0.00001]. Conclusion: Transitional care can significantly promote swallowing function in post-stroke patients with dysphagia, reduce the incidence of complications, improve the daily living ability and self-care ability of patients.