早期活动对机械通气患者病死率影响的累积Meta分析

doi:10.3761/j.issn.0254-1769.2019.06.008

摘要/Abstract

摘要：

目的应用累积Meta分析方法评价早期活动对ICU机械通气患者病死率的影响。方法计算机检索中国生物医学文献数据库、中国学术期刊全文数据库、万方数据库、PubMed、Embase、Web of Science Cochrane Library数据库,搜集关于ICU机械通气患者进行早期活动的随机对照试验,检索时限为建库至2018年12月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,按发表时间顺序进行累积Meta分析,同时采用试验序贯分析方法,评价研究结果的可靠性及真实性。结果共纳入16项研究,包括1 928例患者。累积Meta分析结果显示,早期活动对ICU机械通气患者ICU住院期间的病死率累积效应值为[OR=1.43,95%CI(0.83,2.48)],住院期间病死率累积效应值为[OR=0.92,95%CI(0.72,1.18)],试验序贯分析结果显示,累计的信息量没有穿过传统界值,也没有跨过试验序贯分析界值,且未达到期望信息量(5 064例),因此,可能试验组和对照组疗效差异无统计学意义,仍需要更多的试验来证明。结论现有证据显示,早期活动不增加机械通气患者的病死率。受纳入研究数量和质量的限制,上述结论尚需开展更多研究予以证实。

关键词: 重症监护病房, 通气机, 机械, 早期下床活动, 医院死亡率, Meta分析

Abstract:

Objective To evaluate the effects of early mobilization on mortality in patients with mechanical ventilation in Intensive Care Unit by a cumulative meta-analysis.Methods Databases including CNKI,CBM,WanFang Data,PubMed,Embase,Web of Science,and The Cochrane Library were searched from inception to December 30,2018,to collect randomized controlled trials(RCTs) about early mobilization in patients with mechanical ventilation in Intensive Care Unit. Two reviewers independently screened literature,extracted data,and assessed risk of bias of included studies. A cumulative meta-analysis according to chronological order was performed using STATA 12.0 software,and the trial sequencing analysis(TSA) method was used to assess the reliability and authenticity of the results.Results A total of 16 studies including 1,928 patients were included. The cumulative meta-analysis results showed that the cumulative effect of early mobilization could not increase the mortality during ICU(OR= 1.43,95% CI 0.83 to 2.48) and hospitalization(OR=0.92,95% CI 0.72 to 1.18) in patients with mechanical ventilation. TSA results showed that the cumulative information did not cross the traditional threshold or the TSA threshold,and did not meet the expected information. Therefore,there was no statistical difference in mortality between the intervention group and the control group.Conclusion Existing evidence suggests that early mobilization does not increase the mortality of patients with mechanical ventilation. Due to the limitation of quantity and quality of research,more studies are needed to confirm the above conclusions.

Key words: Intensive Care Units, Ventilators, Mechanical, Early Ambulation, Hospital Mortality, Meta-Analysis

杨丽平, 张志刚, 张彩云, 魏花萍, 孟文勃, 岳伟岗, 姚丽, 丁楠楠, 田金徽. 早期活动对机械通气患者病死率影响的累积Meta分析[J]. 中华护理杂志, 2019, 54(6): 843-849.

YANG Liping, ZHANG Zhigang, ZHANG Caiyun, WEI Huaping, MENG Wenbo, YUE Weigang, YAO Li, DING Nannan, TIAN Jinhui. Effects of early mobilization on mortality in patients with mechanical ventilation in Intensive Care Unit during hospitalization：a cumulative meta-analysis[J]. Chinese Journal of Nursing, 2019, 54(6): 843-849.

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