急性心肌梗死患者经皮冠状动脉介入治疗后早期下床活动效果的系统评价

doi:10.3761/j.issn.0254-1769.2020.10.023

摘要/Abstract

摘要：

目的对急性心肌梗死患者经皮冠状动脉介入治疗后早期下床活动的效果进行评价。方法检索PubMed、EMbase、Cochrane Library、CINAHL、中国生物医学文献数据库、中国知网和万方数据库中对急性心肌梗死PCI术后患者进行早期下床活动干预的临床随机对照试验,采用Cochrane系统评价手册对文献质量进行评价,采用RevMan 5.3进行Meta分析。结果共纳入8篇临床随机对照试验,总样本量586例,文献质量评价等级A级为5篇,B级为3篇。Meta分析结果显示,与对照组相比,试验组左心室射血分数[MD=5.75,95%CI（4.52,6.99）,P<0.001]高于对照组,但出院前两组6 min步行距离的比较,差异无统计学意义;总住院时间明显缩短[MD=-3.84,95%CI（-6.65,-1.02）,P=0.008];试验组术后心脏不良事件发生率[RR=0.44,95%CI（0.25,0.75）,P=0.003]低于对照组,生活质量明显改善。结论早期下床有利于急性心肌梗死患者心肺功能的恢复,减少住院时间,有效防止心脏不良事件的发生,改善患者生活质量。

关键词: 急性心肌梗死, 经皮冠状动脉介入治疗, 早期下床活动, 护理, 系统评价

Abstract:

Objective To evaluate the effects of early clinical activities in patients with acute myocardial infarction after emergency percutaneous coronary intervention（PCI）. Methods PubMed,EMBASE,Cochrane Library,CINAHL,CBM,Wanfang data and CNKI were retrieved by computer for the related clinical randomized control trials on the effects of early ambulation in patients with acute myocardial infarction after emergency PCI. The quality of articles was appraised by the Cochrane Handbook（5.1.0）,and Meta-analysis was carried out with Revman 5.3 software. Results A total of 8 clinical randomized controlled trials were included,with a total sample size of 586 cases,of which 5 were grade A and 3 were grade B. Meta-analysis showed that compared with the control group,the score of left ventricular ejection fraction[MD=5.75,95%CI（4.52,6.99）,P<0.001] was significantly higher in the experimental group than it in the control group. However,there was no significant difference in the 6-minute walking distance between 2 groups at the time of discharge. The total hospital stay was significantly shortened[MD=-3.84, 95%CI（-6.65,-1.02）,P=0.008];the incidence of adverse cardiac events[RR=0.44,95%CI（0.25,0.75）,P=0.003] was significantly reduced in the early intervention group after 6 months of discharge,and the quality of life was significantly improved. Conclusion The early ambulation for patients with acute myocardial infarction is conducive to the recovery of cardiopulmonary function,which can reduce the length of hospital stay,effectively prevent the occurrence of cardiac endpoint events,and improve the quality of life.

Key words: Acute Myocardial Infarction, Percutaneous Coronary Intervention, Early Ambulation, Nursing Care, Systematic Review

谷雨擎, 李庆印, 武杰, 刘裕文. 急性心肌梗死患者经皮冠状动脉介入治疗后早期下床活动效果的系统评价[J]. 中华护理杂志, 2020, 55(10): 1571-1577.

GU Yuqing, LI Qingyin, WU Jie, LIU Yuwen. The effects of early ambulation in patients with acute myocardial infarction after emergency PCI：a systematic review[J]. Chinese Journal of Nursing, 2020, 55(10): 1571-1577.

图/表 3

图1 文献检索流程

Figure 1. Searching process of studies

表1 纳入文献的基本特征

Table 1 Basic characteristics of included studies

表2 纳入研究的方法学质量评价结果

Table 2 Methodological quality evaluation of included studies

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