左心室辅助装置植入患者生活体验质性研究的Meta整合

doi:10.3761/j.issn.0254-1769.2023.10.017

摘要/Abstract

摘要：

目的系统评价与整合左心室辅助装置（left ventricular assist device，LVAD）植入患者的生活体验，为更好地帮助该类人群适应与LVAD共存的生活、建立支持体系提供参考。方法检索Web of Science、PubMed、Embase、Cochrane Library、CINAHL及中国知网、万方数据知识服务平台、维普数据库、中国生物医学文献服务系统中有关LVAD植入患者生活体验的质性研究。检索时间为2008年1月—2022年7月。采用澳大利亚乔安娜布里格斯研究所质性研究质量评价标准评价文献质量，采用Meta整合方法对结果进行整合。结果共纳入15篇英文文献。提取69个主题，归纳为LVAD植入后的健康获益、面临的困境与挑战、自我调适及外部支持对促进恢复与适应至关重要4个整合结果，以及14个类别。结论患者植入LVAD后健康获益明显，但也面临一系列并发症及生活、心理、社会负担。未来应从医疗、家庭、社会等层面建立多维度支持体系，帮助该类患者进行自我调适，协助其尽早重返社会。

关键词: 左心室辅助装置, 生活体验, 质性Meta整合, 循证护理学

Abstract:

Objective To systematically evaluate and integrate the life experience of patients with left ventricular assist device（LVAD） implantation，so as to provide a reference for helping these patients adapt to life coexisting with LVAD and establishing a support system. Methods Web of Science，PubMed，Embase，Cochrane Library，CINAHL，CNKI，Wanfang data，VIP，CBM were searched for qualitative research on life experience of patients with LVAD implantation. The search time was from January 2008 to July 2022. The literature quality evaluation was carried out by the quality evaluation standard of qualitative research of Joanna Briggs Institute，Australia（2016 edition），and the research results were summarized and integrated by the convergent integration method. Results A total of 15 English studies were included；69 themes were extracted；14 categories were summarized and 4 synthesis results were obtained，namely the health benefits，difficulties and challenges，self-adjustment，and the importance of external support after LVAD implantation to promote recovery and adaptation. Conclusion Patients with LVAD have obvious health benefits，but also face a series of complications and life，psychological and social burdens. In the future，a multi-dimensional support system should be established from medical treatment，family and society to help such patients self-adjust and return to society as soon as possible.

Key words: Left Ventricular Assist Device, Life Experience, Qualitative Meta-Synthesis, Evidence-Based Nursing

黎万汇, 岳雯静, 王子涵, 康晓凤, 张辰. 左心室辅助装置植入患者生活体验质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(10): 1261-1268.

LI Wanhui, YUE Wenjing, WANG Zihan, KANG Xiaofeng, ZHANG Chen. A systematic Meta-synthesis of qualitative research on life experience of patients with left ventricular assist device implantation[J]. Chinese Journal of Nursing, 2023, 58(10): 1261-1268.

图/表 3

图1 文献筛选流程图

Figure 1 Literature screening process

表1 纳入文献的基本信息（n=15）

Table 1 Basic characteristics of the included qualitative literature（n=15）

表2 纳入文献的质量评价（n=15）

Table 2 Quality evaluation of the included qualitative literature（n=15）

参考文献 28

[1]	张帅, 侯剑峰. 左心室辅助装置的临床应用现状和展望[J]. 中国循环杂志, 2021, 36(9):916-919.
	Zhang S, Hou JF. Present situation and prospect of clinical application of left ventricular assist device[J]. Chin Circ J, 2021, 36(9):916-919.
[2]	刘湉, 李庆印. 左心室辅助装置植入术后患者运动康复护理研究进展[J]. 中国护理管理, 2022, 22(4):620-626.
	Liu T, Li QY. Progress of exercise rehabilitation nursing after left ventricular assist device implantation[J]. Chin Nurs Manag, 2022, 22(4):620-626.
[3]	严舒, 陈娟, 卢岩, 等. 国内外植入式心室辅助装置研发与应用进展[J]. 中国医学装备, 2022, 19(1):21-26.
	Yan S, Chen J, Lu Y, et al. Progress of development and application of implantable VAD of domestic and overseas[J]. China Med Equip, 2022, 19(1):21-26.
[4]	《中国心血管健康与疾病报告》编写组. 《中国心血管健康与疾病报告2021》概述[J]. 中国心血管病研究, 2022, 20(7):577-596.
	The Writing Committee of the Report on Cardiovascular Health,China DI. Key points of report on cardiovascular health and diseases in China 2021[J]. Chin J Cardiovasc Res, 2022, 20(7):577-596.
[5]	Levelink M, Reinhold AK, Dewald O, et al. Psychological burden and coping in destination therapy patients with a left ventricular assist device:a qualitative content analysis[J]. Artif Organs, 2022, 46(6):1165-1180. DOI URL
[6]	Modica M, Ferratini M, Torri A, et al. Quality of life and emotional distress early after left ventricular assist device implant:a mixed-method study[J]. Artif Organs, 2015, 39(3):220-227. DOI URL
[7]	Trenta AM, Luciani M, Moro M, et al. Self-care in adults with a retro-auricular left ventricular assist device:an interpretive description[J]. Clin Nurs Res, 2022, 31(3):553-562. DOI URL
[8]	Trenta AM, Belloni S, Ausili D, et al. What is the lived experience of patients with left ventricular assist devices during the COVID-19 pandemic? A qualitative analysis[J]. Eur J Cardio-vasc Nurs, 2022, 21(5):438-445.
[9]	Krimminger DM, Sledge JA. A qualitative study of life with a left ventricular assist device as a bridge to transplant:a new normal[J]. Intensive Crit Care Nurs, 2022, 71:103230. DOI URL
[10]	Inyom C, Haese T, Schoenrath F, et al. Lived experiences of patients implanted with left ventricular assist devices[J]. Heart Lung, 2022, 55:155-161. DOI PMID
[11]	Cebeci F, Arikan B, Catal E, et al. A bridge to transplantation:the life experiences of patients with a left ventricular assist device[J]. Heart Lung, 2021, 50(1):106-112. DOI PMID
[12]	Luciani M, Trenta AM, Jack SM, et al. Adults living with a retro-auricular left ventricular assist device as destination therapy:an interpretive description[J]. J Cardiovasc Nurs, 2020, 35(6):E62-E69. DOI URL
[13]	Kitko LA, Hupcey JE, Birriel B, et al. Patients’ decision making process and expectations of a left ventricular assist device pre and post implantation[J]. Heart Lung, 2016, 45(2):95-99. DOI PMID
[14]	Grady KL, Magasi S, Hahn EA, et al. Health-related quality of life in mechanical circulatory support:development of a new conceptual model and items for self-administration[J]. J Heart Lung Transplant, 2015, 34(10):1292-1304. DOI URL
[15]	Sandau KE, Hoglund BA, Weaver CE, et al. A conceptual definition of quality of life with a left ventricular assist device:results from a qualitative study[J]. Heart Lung, 2014, 43(1):32-40. DOI URL
[16]	Ottenberg AL, Cook KE, Topazian RJ, et al. Choices for patients “without a choice”:interviews with patients who received a left ventricular assist device as destination therapy[J]. Circ Cardiovasc Qual Outcomes, 2014, 7(3):368-373. DOI URL
[17]	Marcuccilli L, Casida J, Peters RM. Modification of self-concept in patients with a left-ventricular assist device:an initial exploration[J]. J Clin Nurs, 2013, 22(17/18):2456-2464. DOI URL
[18]	Overgaard D, Grufstedt Kjeldgaard H, Egerod I. Life in transition:a qualitative study of the illness experience and vocational adjustment of patients with left ventricular assist device[J]. J Cardiovasc Nurs, 2012, 27(5):394-402. DOI PMID
[19]	Marcuccilli L, Casida JJ, Peters RM, et al. Sex and intimacy among patients with implantable left-ventricular assist devices[J]. J Cardiovasc Nurs, 2011, 26(6):504-511. DOI PMID
[20]	Casida JM, Marcuccilli L, Peters RM, et al. Lifestyle adjustments of adults with long-term implantable left ventricular assist devices:a phenomenologic inquiry[J]. Heart Lung, 2011, 40(6):511-520. DOI PMID
[21]	Levelink M, Brütt AL. Factors influencing health-related quality of life of patients with a left ventricular assist device:a systematic review and thematic synthesis[J]. Eur J Cardiovasc Nurs, 2021, 20(8):803-815. DOI URL
[22]	Iacovetto MC, Matlock DD, McIlvennan CK, et al. Educational resources for patients considering a left ventricular assist device:a cross-sectional review of Internet,print,and multimedia materials[J]. Circ Cardiovasc Qual Outcomes, 2014, 7(6):905-911. DOI URL
[23]	Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 International Society for Heart and Lung Transplantation guidelines for mechanical circulatory support:executive summary[J]. J Heart Lung Transplant, 2013, 32(2):157-187. DOI URL
[24]	胡亚玲, 兰美娟, 汪春海, 等. 左心室辅助装置与体外膜肺氧合治疗1例心力衰竭患者的护理[J]. 中华护理杂志, 2021, 56(11):1707-1710. DOI URL
	Hu YL, Lan MJ, Wang CH, et al. Postoperative nursing care of a patient with heart failure treated by left ventricular assist device combined with central extracorporeal membrane oxygenation[J]. Chin J Nurs, 2021, 56(11):1707-1710. DOI URL
[25]	Thompson JS, Fitzgerald MD, Allen LA, et al. Shared decision-making for left ventricular assist devices:rationale and design of a nationwide dissemination and implementation project[J]. Circ Cardiovasc Qual Outcomes, 2021, 14(2):e007256.
[26]	Schmidt T, Mewes P, Hoffmann JD, et al. Improved aftercare in LVAD patients:development and feasibility of a smartphone application as a first step for telemonitoring[J]. Artif Organs, 2020, 44(3):248-256. DOI PMID
[27]	张茜, 李永刚, 兰俊, 等. 12例植入左心室辅助装置患者的术后护理[J]. 中华护理杂志, 2021, 56(6):907-911. DOI URL
	Zhang Q, Li YG, Lan J, et al. Post-operative care of 12 patients implanted left ventricular assist system[J]. Chin J Nurs, 2021, 56(6):907-911. DOI URL
[28]	Polastri M, Loforte A. Influence of ventricular assist devices equipment wear on body posture[J]. Artif Organs, 2015, 39(7):640-641. DOI PMID