ICU患者早期活动有效性及安全性影响的系统评价再评价
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摘要
目的探讨ICU患者早期活动的有效性及安全性,为护理人员临床决策提供证据支持。方法计算机检索Cochrane library、CINAHL、PubMed、EMBASE、中国知网、中国生物医学文献数据库、万方数据等,收集ICU患者早期活动相关的系统评价,由2名研究者按纳入与排除标准筛选文献及提取资料。纳入系统评价的方法学质量采用AMSTAR工具进行评价,采用肌力、ICU住院时间、总住院时间、生活质量及功能活动状态作为主要指标对早期活动的有效性进行再评价,通过患者不良反应或安全事件的发生进行早期活动的安全性评价。结果共纳入10篇系统评价。方法学质量评价显示仅有1项研究满足AMSTAR的11个评价条目,其余研究均在不同方面存在缺陷;ICU患者早期活动发生不良事件的概率很低,应用安全性良好,可改善患者肌力、住院时间、生活质量及功能活动状态等。结论 ICU患者进行早期活动安全有效,但该结论的可靠性仍需大样本、高质量的研究进一步证实。
Objective To explore the effectiveness and safety of early mobilization for patients in ICU,so as to provide evidence support for clinical decision-making by nurses.Methods Cochrane library、CINAHL、PubMed、EMBASE、CNKI、CBM and Wanfang Database were searched to obtain the relevant literature.AMSTAR tool was used to assess the methodological quality of the included studies,the effectiveness of early mobilization was evaluated through muscle strength,days of ICU stay,total days of hosptial stay,quality of life and functional status was evaluated via the occurrence of patients' adverse reaction.ResultsTen systematic reviews were included.The methodological quality evaluation showed that only 1study met the 11 evaluation items of AMSTAR.Early mobilization was safe for patients in ICU,which brought low probability of adverse events,and improved the clinical outcomes such as muscle strength,time of hospitalization,quality of life and functional status.Conclusions Early activity in ICU patients is safe and effective,but large sample and high-quality researches are needed to confirm the results.
Objective To explore the effectiveness and safety of early mobilization for patients in ICU,so as to provide evidence support for clinical decision-making by nurses.Methods Cochrane library、CINAHL、PubMed、EMBASE、CNKI、CBM and Wanfang Database were searched to obtain the relevant literature.AMSTAR tool was used to assess the methodological quality of the included studies,the effectiveness of early mobilization was evaluated through muscle strength,days of ICU stay,total days of hosptial stay,quality of life and functional status was evaluated via the occurrence of patients' adverse reaction.ResultsTen systematic reviews were included.The methodological quality evaluation showed that only 1study met the 11 evaluation items of AMSTAR.Early mobilization was safe for patients in ICU,which brought low probability of adverse events,and improved the clinical outcomes such as muscle strength,time of hospitalization,quality of life and functional status.Conclusions Early activity in ICU patients is safe and effective,but large sample and high-quality researches are needed to confirm the results.
引文
[1]中华人民共和国国家统计局.中国统计年鉴[EB/OL].(2017-11-12)[2017-12-20].http://www.stats.gov.cn/tjsj/ndsj/.
[2]DE J B,SHARSHAR T,LEFAUCHEUR J P,et al.Paresis acquired in the intensive care unit:aprospective multicenter study[J].Jama,2002,288(22):2859-2867.
[3]HODGSON C L,BERNEY S,HARROLD M,et al.Clinical review:early patient mobilization in the ICU[J].Crit Care,2013,17(1):207-209.
[4]张莹,米元元.早期康复干预在预防ICU获得性衰弱中的研究进展[J].解放军护理杂志,2017,34(8):48-51.
[5]尉芝苗,聂柳燕,周奇,等.碳酸镧治疗慢性肾脏病高磷血症的系统评价再评价[J].中国循证医学杂志,2016,16(12):1394-1400.
[6]SHEA B J,HAMEL C,WELLS G A,et al.AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews[J].J Clin Epidemiol,2009,62(10):1013-1020.
[7]杨婕,杨蓉,王颖莉.重症监护病房患者早期活动的系统评价[J].中国实用护理杂志,2012,28(35):57-63.
[8]杨丽平,张志刚,张彩云,等.机械通气患者早期主动活动效果的Meta分析[J].中国护理管理,2017,17(6):758-764.
[9]岳萌,姚培宇,崔楚云,等.机械通气患者早期活动效果的系统评价[J].中华护理杂志,2016,51(5):551-557.
[10]赵贵美,焦琳琳,杨桂华.早期循序渐进运动对ICU患者获得性衰弱影响的Meta分析[J].中华护理杂志,2017,52(2):177-181.
[11]AZEVEDO P,GOMES B.Effects of early mobilisation in the functional rehabilitation of critically ill patients:a systematic review[J].Revista De Enfermagem Referencia,2015,N°5(IV Serie):129-138.
[12]LI Z,PENG X,ZHU B,et al.Active mobilization for mechanically ventilated patients:a systematic review[J].Arch Phys Med Rehab,2013,94(3):551-561.
[13]ADLER J,MALONE D.Early mobilization in the intensive care unit:a systematic review[J].J Cardiopulm Phys Ther,2012,23(1):5-13.
[14]CASTROAVILA A C,SERN P,FAN E,et al.Effect of early rehabilitation during intensive care unit stay on functional status:systematic review and meta-analysis[J].Plos One,2015,10(7):e0130722.
[15]LAURENT H,AUBRETON S,RICHARD R,et al.Systematic review of early exercise in intensive care:aqualitative approach[J].Anaesth Crit Care Pa,2016,35(2):133-149.
[16]Tipping CJ,Harrold M,Holland A,et al.The effects of active mobilisation and rehabilitation in ICU on mortality and function:a systematic review[J].Intens Care Med,2016,43(2):1-13.
[17]潘利飞,章仲恒,叶向红,等.ICU患者谵妄的危险因素分析[J].解放军护理杂志,2014,31(1):46-48.
[18]张爱梅,丁爱萍,陆烨华.早期活动预防慢性阻塞性肺疾病机械通气患者ICU获得性衰弱的效果[J].解放军护理杂志,2017,34(15):44-46.
[19]Winkelman C,Johnson K D,Hejal R,et al.Examining the positive effects of exercise in intubated adults in ICU:a prospective repeated measures clinical study[J].Intens Crit Care Nurs,2012,28(6):307-318.
[20]Martin A D,Smith B K,Davenport P D,et al.Inspiratory muscle strength training improves weaning outcome in failure to wean patients:a randomized trial[J].Crit Care,2011,15(2):R84.
[21]Giavedoni S,Deans A,Mccaughey P,et al.Neuromuscular electrical stimulation prevents muscle function deterioration in exacerbated COPD:apilot study[J].Resp Med,2012,106(10):1429-1434.
[22]张娜,张兵.早期活动预防ICU获得性衰弱的研究进展[J].解放军护理杂志,2014,31(5):43-45.
[23]胡惠娟,魏红云,徐杰,等.早期活动干预对ICU获得性肌无力病人的影响[J].护理研究,2014,28(9C):3378-3379.
[24]DICENSO A,BAYLEY L,HAYNES R B.Accessing preappraised evidence:fine-tuning the 5S model into a 6Smodel[J].Ann Intern Med,2009,151(6):99-101.
[2]DE J B,SHARSHAR T,LEFAUCHEUR J P,et al.Paresis acquired in the intensive care unit:aprospective multicenter study[J].Jama,2002,288(22):2859-2867.
[3]HODGSON C L,BERNEY S,HARROLD M,et al.Clinical review:early patient mobilization in the ICU[J].Crit Care,2013,17(1):207-209.
[4]张莹,米元元.早期康复干预在预防ICU获得性衰弱中的研究进展[J].解放军护理杂志,2017,34(8):48-51.
[5]尉芝苗,聂柳燕,周奇,等.碳酸镧治疗慢性肾脏病高磷血症的系统评价再评价[J].中国循证医学杂志,2016,16(12):1394-1400.
[6]SHEA B J,HAMEL C,WELLS G A,et al.AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews[J].J Clin Epidemiol,2009,62(10):1013-1020.
[7]杨婕,杨蓉,王颖莉.重症监护病房患者早期活动的系统评价[J].中国实用护理杂志,2012,28(35):57-63.
[8]杨丽平,张志刚,张彩云,等.机械通气患者早期主动活动效果的Meta分析[J].中国护理管理,2017,17(6):758-764.
[9]岳萌,姚培宇,崔楚云,等.机械通气患者早期活动效果的系统评价[J].中华护理杂志,2016,51(5):551-557.
[10]赵贵美,焦琳琳,杨桂华.早期循序渐进运动对ICU患者获得性衰弱影响的Meta分析[J].中华护理杂志,2017,52(2):177-181.
[11]AZEVEDO P,GOMES B.Effects of early mobilisation in the functional rehabilitation of critically ill patients:a systematic review[J].Revista De Enfermagem Referencia,2015,N°5(IV Serie):129-138.
[12]LI Z,PENG X,ZHU B,et al.Active mobilization for mechanically ventilated patients:a systematic review[J].Arch Phys Med Rehab,2013,94(3):551-561.
[13]ADLER J,MALONE D.Early mobilization in the intensive care unit:a systematic review[J].J Cardiopulm Phys Ther,2012,23(1):5-13.
[14]CASTROAVILA A C,SERN P,FAN E,et al.Effect of early rehabilitation during intensive care unit stay on functional status:systematic review and meta-analysis[J].Plos One,2015,10(7):e0130722.
[15]LAURENT H,AUBRETON S,RICHARD R,et al.Systematic review of early exercise in intensive care:aqualitative approach[J].Anaesth Crit Care Pa,2016,35(2):133-149.
[16]Tipping CJ,Harrold M,Holland A,et al.The effects of active mobilisation and rehabilitation in ICU on mortality and function:a systematic review[J].Intens Care Med,2016,43(2):1-13.
[17]潘利飞,章仲恒,叶向红,等.ICU患者谵妄的危险因素分析[J].解放军护理杂志,2014,31(1):46-48.
[18]张爱梅,丁爱萍,陆烨华.早期活动预防慢性阻塞性肺疾病机械通气患者ICU获得性衰弱的效果[J].解放军护理杂志,2017,34(15):44-46.
[19]Winkelman C,Johnson K D,Hejal R,et al.Examining the positive effects of exercise in intubated adults in ICU:a prospective repeated measures clinical study[J].Intens Crit Care Nurs,2012,28(6):307-318.
[20]Martin A D,Smith B K,Davenport P D,et al.Inspiratory muscle strength training improves weaning outcome in failure to wean patients:a randomized trial[J].Crit Care,2011,15(2):R84.
[21]Giavedoni S,Deans A,Mccaughey P,et al.Neuromuscular electrical stimulation prevents muscle function deterioration in exacerbated COPD:apilot study[J].Resp Med,2012,106(10):1429-1434.
[22]张娜,张兵.早期活动预防ICU获得性衰弱的研究进展[J].解放军护理杂志,2014,31(5):43-45.
[23]胡惠娟,魏红云,徐杰,等.早期活动干预对ICU获得性肌无力病人的影响[J].护理研究,2014,28(9C):3378-3379.
[24]DICENSO A,BAYLEY L,HAYNES R B.Accessing preappraised evidence:fine-tuning the 5S model into a 6Smodel[J].Ann Intern Med,2009,151(6):99-101.