姑息照护在心力衰竭患者中应用效果的系统评价

目的系统评价姑息照护干预心力衰竭患者的疗效。方法计算机检索PubMed、EMbase、CINAHL、The Cochrane Library、VIP、CNKI、CBM和WanFang Data数据库,搜集关于姑息照护干预心衰患者疗效的随机对照试验(RCT),检索时限均为建库至2021年9月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入11个RCT,包括912例患者。Meta分析结果显示,姑息照护可提高心力衰竭患者的生活质量KCCQ或McGill QoL量表:SMD=0.85,95%CI(0.13,1.58),P=0.02;MLHFQ量表:SMD=-1.32,95%CI(-2.10,-0.54),P=0.0009]、降低患者抑郁水平SMD=-0.58,95%CI(-0.87,-0.28),P=0.0001]与焦虑水平SMD=-0.51,95%CI(-0.89,-0.13),P=0.008]、改善不良症状SMD=-1.46,95%CI(-2.67,-0.24),P=0.02],减少人均住院时间MD=-0.94,95%CI(-1.28,-0.60),P<0.00001]和降低再入院率RR=0.64,95%CI(0.42,0.98),P=0.04],但对于患者的死亡率RR=1.00,95%CI(0.63,1.57),P=0.99]并无明显影响。结论当前有限证据表明,姑息照护可改善心衰患者生活质量、情绪状态、不良症状,减少住院时间和降低再入院率。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Efficacy of palliative care in heart failure patients:a systematic review

Objective To systematically review the efficacy of palliative care in heart failure patients.Methods PubMed,EMbase,CINAHL,The Cochrane Library,VIP,CNKI,CBM and WanFang Data databases were electronically searched to collect randomized controlled trials(RCTs)on the efficacy of palliative care in heart failure patients from inception to September 2021.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies;then,meta-analysis was performed using RevMan 5.3 software.Results A total of 11 RCTs involving912 patients were included.The results of meta-analysis showed that palliative care could improve the quality of life of patients with heart failure(KCCQ&McGill QoL:SMD=0.85,95%CI 0.13 to 1.58,P=0.02;MLHFQ:SMD=-1.32,95%CI-2.10 to-0.54,P=0.0009),reduce the level of depression(SMD=-0.58,95%CI-0.87 to-0.28,P=0.0001)and anxiety(SMD=-0.51,95%CI-0.89 to-0.13,P=0.008),improve the adverse symptoms(SMD=-1.46,95%CI-2.67 to-0.24,P=0.02),reduce the readmission rate(RR=0.64,95%CI 0.42 to 0.98,P=0.04)and the per hospitalization time(MD=-0.94,95%CI-1.28 to-0.60,P<0.00001).However,it had no obvious effect on the mortality of patients(RR=1.00,95%CI 0.63 to 1.57,P=0.99).Conclusion Current evidence shows that palliative care can improve the quality of life,emotional state and adverse symptoms of patients with heart failure,and reduce the length of hospital stay and readmission rate.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify the above conclusion.