集束化护理预防血液透析导管相关血流感染的Meta分析
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摘要
目的评价集束化护理预防血液透析导管相关血流感染的效果。方法以英文检索词Patient Care Bundles、Care Bundles、Care Bundle、RenalDialysis、RenalDialyses、Hemodialysis、Extracorporeal Dialyses、Extracorporeal Dialysis、blood dialysis、catheter related blood stream infection、CRBSI、catheter-related bloodstream infections等检索Pubmed、EMBASE、Cochrane Library、Web Of Sicence;以中文检索词集束化护理、集束化策略、集束化管理、血液透析、肾透析、导管相关血流感染等检索中国生物医学文献数据库、万方数据库、中国知网、维普期刊资源整合服务平台,时间限定为建库至2018年8月31日;收集所有关于集束化护理预防血液透析导管相关血流感染的随机对照试验(randomized controlled trial,RCT)。两位评审员进行文献筛选、方法学质量评价及数据资料提取,Revman5.3进行数据分析。TSA进行试验序贯分析。结果一共纳入12项研究,其中试验组985例,对照组985例。Meta分析结果显示:集束化护理能降低血液透析患者导管相关血流感染的发生率,RR=0.16,95%CI[0.10,0.25],P<0.00001,差异具有统计学意义。试验序贯分析显示:导管相关血流感染的发生率这个指标要达到显著性检验水平所需RIS为6874例,纳入研究样本量(1970例)未达到了RIS,但同时穿过了传统界值和TSA界值,提示研究结果提前得到了证明。结论集束化护理预防血液透析导管相关血流感染的发生,值得在临床推广。
Objective Application of the effects of Care Bundles prevents hemodialysis catheter related bloodstream infections. Methods The key words in English Patient Care Bundles,Care Bundles, Care Bundles, Dialysis, Dialyses, Hemodialysis, Extracorporeal Dialyses, Extracorporeal Dialysis,Search Pubmed, EMBASE, Cochrane Library, Web Of Sicence and so on. Chinese retrieval words: cluster nursing, cluster strategy, cluster management, hemodialysis, renal dialysis, catheter-related bloodstream infection, etc. All randomized controlled trials(RCT) were collected for the prevention of hemodialysis catheter related bloodstream infections with intensive care. Two reviewers conducted literature screening, methodological quality evaluation and data extraction, and Revman5.3 conducted data analysis. TSA conducts test sequence analysis. Results A total of 12 literatures were included, including 985 in the experimental group and 985 in the control group. Meta-analysis results showed that Care Bundles can reduce the incidence of CRBSI in hemodialysis patients, RR=0.16, 95%CI[0.10, 0.25], P<0.00001, and the difference is statistically significant. According to the sequential analysis of the experiment, the RIS needed to achieve the significance test level was 6,874 cases for the incidence of CRBSI, and the included sample size(1970 cases) did not reach the RIS, but passed the traditional boundary value and TSA boundary value simultaneously, suggesting that the research results were proved in advance. Conclusion Care Bundles for prevention of hemodialysis catheter related bloodstream infection is worthy of clinical promotion.
Objective Application of the effects of Care Bundles prevents hemodialysis catheter related bloodstream infections. Methods The key words in English Patient Care Bundles,Care Bundles, Care Bundles, Dialysis, Dialyses, Hemodialysis, Extracorporeal Dialyses, Extracorporeal Dialysis,Search Pubmed, EMBASE, Cochrane Library, Web Of Sicence and so on. Chinese retrieval words: cluster nursing, cluster strategy, cluster management, hemodialysis, renal dialysis, catheter-related bloodstream infection, etc. All randomized controlled trials(RCT) were collected for the prevention of hemodialysis catheter related bloodstream infections with intensive care. Two reviewers conducted literature screening, methodological quality evaluation and data extraction, and Revman5.3 conducted data analysis. TSA conducts test sequence analysis. Results A total of 12 literatures were included, including 985 in the experimental group and 985 in the control group. Meta-analysis results showed that Care Bundles can reduce the incidence of CRBSI in hemodialysis patients, RR=0.16, 95%CI[0.10, 0.25], P<0.00001, and the difference is statistically significant. According to the sequential analysis of the experiment, the RIS needed to achieve the significance test level was 6,874 cases for the incidence of CRBSI, and the included sample size(1970 cases) did not reach the RIS, but passed the traditional boundary value and TSA boundary value simultaneously, suggesting that the research results were proved in advance. Conclusion Care Bundles for prevention of hemodialysis catheter related bloodstream infection is worthy of clinical promotion.
引文
[1]M Hamada Imam, E Gamal.Procalcitonin level as a surrogate for catheterrelated blood stream infection among hemodialysis patients[J].J Vasc Access,2017,18(6):498-502.
[2]V Gupta,M Yassin.Infection and hemodialysis access:an updated review[J].Infect Disord Drug Targets,2013,13(3):196-205.
[3]R Katneni, S Hedayati.Central venous catheter-related bacteremia in chronic hemodialysis patients:epidemiology and evidence-based management[J].Nat Clin Pract Nephrol,2007,3(5):256-66.
[4]江培兰,蔡照红,吴兰.血液透析导管相关性血流感染患者集束化护理干预的预防作用[J].中华医院感染学杂志,2015(8):1805-1807.
[5]傅丽丽,陈颖,王云燕,等.血液透析患者中心静脉导管相关性血流感染研究进展[J].解放军预防医学杂志,2016(s1):52-53.
[6]E Robb, B Jarman, G Suntharalingam, et al.Using care bundles to reduce inhospital mortality:quantitative survey[J].BMJ,2010(340):c1234.
[7]QChen,YYu,QWang,etal.Applicationofclusteringnursing strategy in preventing complications of hemodialysis catheter[J].Today Nurse,2015(2):105-106.
[8]余美花,周文英,马金强.集束化护理在预防血液透析导管相关性血流感染的效果分析[J].中华医院感染学杂志,2014,(11):2704-2705.
[9]B J Rijnders, S J Vandecasteele, W E Van, et al.Use of semiautomatic treatment advice to improve compliance with Infectious Diseases Society of America guidelines for treatment of intravascular catheter-related infection:a before-after study[J].Clinical Infectious Diseases,2003,37(7):980-983.
[10]J Higgins.Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration[J].Naunyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie,2008,5(2):S38.
[11]蔡永平,王笑丽,徐辉.集束化护理在预防血液透析导管相关血流感染的效果分析及护理对策探讨[J].中国现代药物应用,2015(21):230-231.
[12]陈丽清.集束化护理预防血液透析导管相关性感染(CRBSI)的效果研究[J].中国卫生标准管理,2017,8(22):147-148.
[13]程梅.集束化护理理念在血液透析患者血管通路风险管理中的应用[J].中国现代药物应用,2015,9(22):209-211.
[14]赖瑜娜.集束化护理在维持性血液透析患者中的应用[J].中医临床研究,2017,9(15):36-37.
[15]李旭丹.集束化护理在预防血液透析导管相关血流感染的效果分析及护理[J].中国卫生标准管理,2016,7(12):200-201.
[16]林宇雨,张桂友,林丽容,等.集束化护理对血液透析导管相关血流感染发生的干预意义分析[J].中国医学创新,2017,14(2):106-108.
[17]缪健丽,杨丽平,张秋萍.集束化护理对预防血透患者血液透析导管相关并发症的影响[J].中国医学创新,2017,14(19):94-98.
[18]欧玉珍.探讨集束化护理在预防血液透析导管相关性血流感染的应用[J].中国现代药物应用,2017,11(7):169-170.
[19]尚美蓉.集束化护理在预防血液透析导管相关血流感染中的护理效果[J].中国继续医学教育,2017(34):144-145.
[20]王燕玉.集束化护理对降低血液净化科CRBSI发生率的效果分析[J].现代医学,2015(1):113-115.
[21]徐利萍.集束化护理干预对血液透析患者并发症与营养状况的影响[J].护理实践与研究,2017,14(12):48-49.
[22]臧二梅.集束化护理预防血液透析导管相关性感染的效果[C]//中国转化医学和整合医学研讨,2015.
[23]吴佼佼,马红梅,廖春霞,等.集束化护理预防ICU患者呼吸机相关性肺炎的meta分析[J].职业与健康,2016,32(24):3336-3340.
[24]Y C Ding, Q Y Shi.Effects of cluster nursing intervention on nutritional status, microinflammatory response and complications in maintenance hemodialysis patients[J].Today Nurse,2018(2):121-123.
[25]马靓,张立元,许勤.维持性血液透析患者中心静脉导管相关性血流感染及预防的研究进展[J].中华护理杂志,2010,45(1):85-88.
[26]R Resar, P Pronovost, C Haraden, et al.Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia[J].Joint Commission Journal on Quality&Patient Safety,2005,31(5):243-8.
[27]JRello,HGLode,RMasterton.AEuropeancarebundlefor preventionofventilator-associatedpneumonia[J].IntensiveCare Medicine,2010,36(5):773-780.
[28]K H Lee, N H Cho, S J Jeong, et al.Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections[J].Yonsei Med J,2018,59(3):376-382.
[2]V Gupta,M Yassin.Infection and hemodialysis access:an updated review[J].Infect Disord Drug Targets,2013,13(3):196-205.
[3]R Katneni, S Hedayati.Central venous catheter-related bacteremia in chronic hemodialysis patients:epidemiology and evidence-based management[J].Nat Clin Pract Nephrol,2007,3(5):256-66.
[4]江培兰,蔡照红,吴兰.血液透析导管相关性血流感染患者集束化护理干预的预防作用[J].中华医院感染学杂志,2015(8):1805-1807.
[5]傅丽丽,陈颖,王云燕,等.血液透析患者中心静脉导管相关性血流感染研究进展[J].解放军预防医学杂志,2016(s1):52-53.
[6]E Robb, B Jarman, G Suntharalingam, et al.Using care bundles to reduce inhospital mortality:quantitative survey[J].BMJ,2010(340):c1234.
[7]QChen,YYu,QWang,etal.Applicationofclusteringnursing strategy in preventing complications of hemodialysis catheter[J].Today Nurse,2015(2):105-106.
[8]余美花,周文英,马金强.集束化护理在预防血液透析导管相关性血流感染的效果分析[J].中华医院感染学杂志,2014,(11):2704-2705.
[9]B J Rijnders, S J Vandecasteele, W E Van, et al.Use of semiautomatic treatment advice to improve compliance with Infectious Diseases Society of America guidelines for treatment of intravascular catheter-related infection:a before-after study[J].Clinical Infectious Diseases,2003,37(7):980-983.
[10]J Higgins.Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration[J].Naunyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie,2008,5(2):S38.
[11]蔡永平,王笑丽,徐辉.集束化护理在预防血液透析导管相关血流感染的效果分析及护理对策探讨[J].中国现代药物应用,2015(21):230-231.
[12]陈丽清.集束化护理预防血液透析导管相关性感染(CRBSI)的效果研究[J].中国卫生标准管理,2017,8(22):147-148.
[13]程梅.集束化护理理念在血液透析患者血管通路风险管理中的应用[J].中国现代药物应用,2015,9(22):209-211.
[14]赖瑜娜.集束化护理在维持性血液透析患者中的应用[J].中医临床研究,2017,9(15):36-37.
[15]李旭丹.集束化护理在预防血液透析导管相关血流感染的效果分析及护理[J].中国卫生标准管理,2016,7(12):200-201.
[16]林宇雨,张桂友,林丽容,等.集束化护理对血液透析导管相关血流感染发生的干预意义分析[J].中国医学创新,2017,14(2):106-108.
[17]缪健丽,杨丽平,张秋萍.集束化护理对预防血透患者血液透析导管相关并发症的影响[J].中国医学创新,2017,14(19):94-98.
[18]欧玉珍.探讨集束化护理在预防血液透析导管相关性血流感染的应用[J].中国现代药物应用,2017,11(7):169-170.
[19]尚美蓉.集束化护理在预防血液透析导管相关血流感染中的护理效果[J].中国继续医学教育,2017(34):144-145.
[20]王燕玉.集束化护理对降低血液净化科CRBSI发生率的效果分析[J].现代医学,2015(1):113-115.
[21]徐利萍.集束化护理干预对血液透析患者并发症与营养状况的影响[J].护理实践与研究,2017,14(12):48-49.
[22]臧二梅.集束化护理预防血液透析导管相关性感染的效果[C]//中国转化医学和整合医学研讨,2015.
[23]吴佼佼,马红梅,廖春霞,等.集束化护理预防ICU患者呼吸机相关性肺炎的meta分析[J].职业与健康,2016,32(24):3336-3340.
[24]Y C Ding, Q Y Shi.Effects of cluster nursing intervention on nutritional status, microinflammatory response and complications in maintenance hemodialysis patients[J].Today Nurse,2018(2):121-123.
[25]马靓,张立元,许勤.维持性血液透析患者中心静脉导管相关性血流感染及预防的研究进展[J].中华护理杂志,2010,45(1):85-88.
[26]R Resar, P Pronovost, C Haraden, et al.Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia[J].Joint Commission Journal on Quality&Patient Safety,2005,31(5):243-8.
[27]JRello,HGLode,RMasterton.AEuropeancarebundlefor preventionofventilator-associatedpneumonia[J].IntensiveCare Medicine,2010,36(5):773-780.
[28]K H Lee, N H Cho, S J Jeong, et al.Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections[J].Yonsei Med J,2018,59(3):376-382.