远程干预对居家脊髓损伤患者压力性损伤预防效果的系统评价

doi:10.3761/j.issn.0254-1769.2022.13.015

摘要/Abstract

摘要：

目的系统评价远程干预在居家脊髓损伤患者压力性损伤预防中的应用效果,为临床干预提供循证依据。方法计算机检索中国生物医学文献数据库、中国知网、万方数据库、维普数据库、Cochrane Library、PubMed、Embase、Web of Science、Scopus、ProQuest和BMJ Best Practice从建库到2021年8月收录的相关文献。由2名研究人员进行质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入14篇文献,包括9项随机对照试验和5项类实验研究,共1 582例患者。Meta分析结果显示,远程干预能降低居家脊髓损伤患者压力性损伤的发生率[RR=0.29, 95%CI（0.20,0.43）,P<0.001],提高患者的生活质量[SMD=0.94,95%CI（0.19,1.68）,P=0.010]和满意度[SMD=0.86, 95%CI（0.58,1.13）,P<0.001];不良事件发生率比较,差异无统计学意义[RR=0.50,95%CI（0.20,1.27）,P=0.140]。结论远程干预在居家脊髓损伤患者压力性损伤预防中是安全、可行的,能降低其压力性损伤的发生率,提高患者的生活质量和满意度。受纳入研究质量和数量的限制,上述结论尚需更多高质量的研究验证。

关键词: 脊髓损伤, 压力性损伤, 远程干预, 系统评价, 循证护理学

Abstract:

Objective To systematically review the effect of telemedicine on the prevention of pressure injury among community-dwelling patients with spinal cord injury,and to provide evidence-based bases for future research. Methods Both Chinese and English databases（CBM,CNKI,WanFang,VIP,Cochrane Library,PubMed,Embase,Web of Science,Scopus,ProQuest and BMJ Best Practice） were searched from their inception to August 2021. 2 researchers evaluated the quality of the included articles,and the meta-analysis was performed by RevMan 5.3 software. Results A total of 14 articles were included （9 randomized controlled trials and 5 quasi-experimental studies）,with totally 1 582 community-dwelling patients with spinal cord injury. The results of meta-analysis showed that telemedicine can decrease the incidence of pressure injury in community-dwelling patients with spinal cord injury [RR=0.29,95%CI（0.20,0.43）,P<0.001],improve the quality of life[SMD=0.94,95%CI（0.19,1.68）,P=0.010] and satisfaction[SMD=0.86,95%CI（0.58,1.13）,P<0.001],and the incidence of adverse events caused by pressure injury did not increase significantly[RR=0.50,95%CI（0.20,1.27）,P=0.140]. Conclusion The current evidence shows that telemedicine could decrease the incidence of pressure injury,improve quality of life and satisfaction in community-dwelling patients with spinal cord injury,proving that telemedicine is safe and feasible. Due to the limited quality and quantity of included articles,the above conclusion needs to be verified by more high-quality studies.

Key words: Spinal Cord Injuries, Pressure Injury, Telemedicine, Systematic Review, Evidence-Based Nursing

陈桂莲, 王颖敏, 王彤, 钟丽容, 何杏辉, 贾萌萌, 李琨. 远程干预对居家脊髓损伤患者压力性损伤预防效果的系统评价[J]. 中华护理杂志, 2022, 57(13): 1627-1633.

CHEN Guilian, WANG Yingmin, WANG Tong, ZHONG Lirong, HE Xinghui, JIA Mengmeng, LI Kun. Effect of telemedicine on prevention of pressure injury among community-dwelling patients with spinal cord injury：a systematic review[J]. Chinese Journal of Nursing, 2022, 57(13): 1627-1633.

图/表 4

图1 文献筛选流程图

Figure 1 Flow diagram of literature screening

表1 纳入文献的基本特征（n=14）

Table 1 Characteristics of included studies（n=14）

表2 随机对照试验的方法学质量评价结果（n=9）

Table 2 Methodological quantity evaluation of randomized controlled trials（n=9）

图2 远程干预对居家脊髓损伤患者压力性损伤发生率的影响

Figure 2 The effect of telemedicine on the incidence of pressure injury in community-dwelling patients with spinal cord injury

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