早期活动护理对ICU机械通气患者康复效果的Meta分析

Meta-Analysis of the Effect of Early Activity Nursing on the Rehabilitation of Patients with Mechanical Ventilation in ICU

摘要: 目的：运用系统评价的方法探讨早期活动护理对ICU机械通气患者的康复效果，为临床护理提供证据支持。方法：本研究共检索中国知网、PubMed、Embase、维普、万方等5个中英文数据库，根据纳入及排除标准筛选出2010年1月1日至2021年12月1日发表的对ICU机械通气患者进行早期活动护理的随机对照试验(RCT)，逐一对纳入研究进行质量评价，并使用RevMan 5.4软件对最终纳入的RCT进行Meta分析。结果：最终共纳入12项研究，共涉及1005例ICU机械通气患者，整体文章质量不高。Meta分析结果显示：对于ICU机械通气患者，实施早期活动护理干预与常规护理相比，患者机械通气时间更短(MD = −2.76, 95% CI (−3.69, −1.84), P < 0.00001)、入住ICU时间更短(MD = −3.38, 95% CI (−4.20, −2.56), P < 0.00001)、日常生活能力评分(Barthel指数)更高(MD = 14.93, 95% CI (5.86, 23.99), P < 0.00001)、发生呼吸机相关性肺炎(VAP)概率更低(OR = 0.25, 95% CI (0.13, 0.47), P < 0.0001)、发生获得性衰弱(ICU-AW)概率更低(OR = 0.16, 95% CI (0.09, 0.27), P < 0.00001)，差异均具有统计学意义。结论：对ICU机械通气患者实施早期活动护理康复效果确切。但受纳入文献质量影响，上述结论需要更高质量研究验证。

Abstract: Objective: To explore the rehabilitation effect of early active nursing on ICU patients with mechani-cal ventilation by using the method of systematic evaluation, and to provide evidence support for clinical nursing. Methods: In this study, 5 Chinese and English databases including CNKI.com, Pub-Med, Embase, VIP and Wanfang were searched. Randomized controlled trials (RCTS) of early active care for ICU mechanical ventilation patients published from January 1, 2010 to December 1, 2021 were screened according to inclusion and exclusion criteria, and the quality of each included study was evaluated. Meta-analysis was performed on the included RCTS using RevMan 5.4 software. Re-sults: A total of 12 studies were included, involving 1005 ICU mechanical ventilation patients. The overall quality of the articles was not high. Meta-analysis results showed that: For patients with mechanical ventilation in ICU, compared with conventional nursing, early active nursing interven-tion had shorter mechanical ventilation time (MD = −2.76, 95% CI (−3.69, −1.84), P < 0.00001) and shorter stay in ICU (MD = −3.38, 95% CI (−4.20, −2.56), P < 0.00001), Barthel index (MD = 14.93, 95% CI (5.86, 23.99), P < 0.00001), lower probability of ventilator associated pneumonia (VAP) (OR = 0.25, 95% CI (0.13, 0.47), P < 0.0001), lower probability of acquired ascetic (ICU-AW) (OR = 0.16, 95% CI (0.09, 0.27), P < 0.00001); the differences were statistically significant. Conclusion: Early ac-tivity nursing and rehabilitation is effective for ICU mechanical ventilation patients. However, due to the impact of the quality of the included literature, the above conclusions need to be verified by higher-quality studies.