出院准备服务对慢性阻塞性肺疾病患者干预效果的Meta分析

目的 通过Meta分析评价出院准备服务在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者中的应用效果。方法 计算机检索PubMed、Cochrane Library、Web of Science、CINAHL、Embase、OVID、中国知网、中国生物医学文献数据库、万方数据库中有关COPD患者出院准备服务的随机对照试验,检索时限为建库至2021年3月。由2名研究者独立筛选文献、提取资料并进行质量评价,使用RevMan 5.2软件进Meta分析。结果 最终纳入14篇文献,共2 023例患者。Meta分析结果显示,与常规护理相比,出院准备服务可以降低COPD患者的再入院率[OR=0.62,95%CI(0.48, 0.80),Z=3.69,P<0.001],减少再入院次数[MD=-0.57,95%CI(-0.96,-0.19),Z=2.94,P=0.003]和住院时间[MD=-1.77,95%CI(-2.78,-0.76),Z=3.42,P<0.001],降低患者呼吸困难指数[MD= -0.39,95%CI(-0.70,-0.09),Z=2.56,P=0.010];在生活质量方面,以乔治呼吸问卷评价时,差异无统计学意义[MD=-3.27,95%CI(-7.57,1.03),Z=1.49,P=0.140],采用西雅图阻塞性肺疾病量表评价时,出院准备服务可提高生活质量[MD=49.38,95%CI(43.11,55.65),Z=15.43,P<0.001];在降低病死率方面,差异无统计学意义[OR=0.90,95%CI(0.61,1.34),Z=0.50,P=0.620]。 结论 出院准备服务能有效降低COPD患者的再入院率、减少再入院次数和住院时间、改善呼吸困难症状,但对病死率和生活质量的影响尚不确定,仍需更多高质量的研究进一步论证。

Intervention effects of discharge preparation service on patients with chronic obstructive pulmonary diseases:a meta-analysis

Objective To evaluate the effect of discharge preparation service in patients with chronic obstructive pulmonary disease (COPD) through meta-analysis. Methods A systematic search of PubMed,Cochrane Library,Web of Science,CINAHL,Embase,OVID,CNKI,CBM and Wanfang database was carried out to collect randomized controlled trials(RCTs) on discharge preparation service for COPD patients from inception to March 2021. Literature screening,information extraction and quality evaluation were conducted by 2 reviewers,and RevMan 5.2 software was adopted for meta-analysis. Results A total of 14 RCTs with 2 023 patients were finally included. The results showed that discharge preparation services reduced readmission rates [OR=0.62,95%CI(0.48,0.80),Z=3.69,P<0.001],the number of readmissions [MD=-0.57,95%CI(-0.96,-0.19),Z=2.94,P=0.003] and length of stay [MD=-1.77,95%CI (-2.78,-0.76),Z=3.42,P<0.001],and improved MMRC [MD=-0.39,95%CI(-0.70,-0.09),Z=2.56,P=0.010]. There was no significant difference in quality of life by the SGRQ [MD=-3.27,95%CI(-7.57,1.03),Z=1.49,P=0.140]. The quality of life was improved by the SOLDQ [MD=49.38,95%CI(43.11,55.65),Z=15.43,P<0.001]. There was no significant difference in reducing mortality [OR=0.90,95%CI(0.61,1.34),Z=0.50,P=0.620]. Conclusion Discharge pre-paration service can effectively reduce the readmission rate,the number of readmissions and length of stay,and improve MMRC in patients with COPD,but the impact on mortality and quality of life is still uncertain,and high-quality research is still needed for further demonstration.