摘要
[目的]应用累积Meta分析方法评价早期活动对机械通气病人重症监护病房(ICU)获得性肌无力(ICU⁃AW)的影响,并运用试验序贯分析检验Meta分析结果的真实性。[方法]计算机检索the Cochrane Library、PubMed、EMbase、中国知网(CNKI)、维普数据库(VIP)、万方数据库从建库至2019年9月25日公开发表的关于早期活动干预用于ICU机械通气病人的临床随机对照研究(RCT),由2名研究员独立筛选文献、评价文献质量并提取资料。对符合质量标准的研究按发表时间顺序进行累计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和真实性。[结果]共纳入12篇文献,包括研究对象979例。累计Meta分析结果显示:与常规护理比较,早期活动能够提高机械通气病人肌力,累计效应值SMD=1.47,95%CI(1.21,1.72);早期活动可降低ICU⁃AW发生率,累计效应值RR=0.31,95%CI(0.16,0.60);试验序贯分析结果显示:两指标虽未达到期望信息量,但累积的Z值线穿过了传统界值,同时跨过了试验序贯分析界值,说明可能两组疗效差异有统计学意义,且无须更多试验来证明。[结论]早期活动能够提高病人的肌力,减少ICU⁃AW的发生。
Objective:To evaluate effect of early mobilization on ICU⁃acquired weakness(ICU⁃AW)in patients with mechanical ventilation by a cumulative Meta⁃analysis.And to verity results'authenticity of cumulative Meta-analysis by trial sequential analysis(TSA).Methods:Randomized controlled trials(RCTs)on early mobilization interventions in ICU mechanical ventilation patients were retrieved from the Cochrane Library,PubMed,EMbase,CNKI,VIP,and Wanfang Database.these RCTs were published from databases establishment to September 25,2019.Screening of literature,evaluation of quality of literatures and extraction of data were performed by two researchers independently.A cumulative Meta⁃analysis was conducted on studies meeting quality standards,according to time sequence of publication.Meanwhile,a sequential analysis method was used to evaluate reliability and authenticity of research results.Results:A total of 12 literatures were included,involving 979 patients.The cumulative Meta-analysis results showed that compared with control group,early mobilization could improve muscle strength in patients with mechanical ventilation,with a cumulative effect value of SMD=1.47,95%CI(1.21,1.72).And it also reduce incidence of ICU⁃acquired weakness,with a cumulative effect value of RR=0.31,95%CI(0.16,0.60).Results of trial sequential analysis showed that two indexes did not reach the expected information content,while cumulative Z value crossed traditional threshold and threshold of trial sequential analysis.Therefore,it indicated that efficacy difference between two groups could be statistically significant.And there is no need to develop more tests to verify it.Conclusions:Early mobilization can improve muscle strength and reduce occurrence of ICU⁃AW.
作者
胡燕
李冬英
胡晓莹
肖伽
李瑛
HU Yan;LI Dongying;HU Xiaoying;XIAO Jia;LI Ying(The Second Affiliated Hospital of Nanchang University,Jiangxi 330006 China)
出处
《护理研究》
北大核心
2020年第18期3190-3196,共7页
Chinese Nursing Research
基金
江西省科技计划项目,编号:20181BBG70023。
关键词
早期活动
机械通气
ICU获得性肌无力
肌力
累计Meta分析
early mobilization
mechanical ventilation
ICU⁃acquired weakness
muscle strength
cumulative Meta⁃analysis
