以人为本的护理对认知症患者有效性的meta分析
宫 晶 ( 潍坊医学院 护理学院 )
李景余 ( 潍坊医学院 护理学院 )
孙亚楠 ( 潍坊医学院 护理学院 )
丁良成 ( 潍坊医学院 护理学院 )
吕慧静 ( 潍坊医学院 护理学院 )
臧丽丽 ( 潍坊医学院 护理学院 )
孟庆慧 ( 潍坊医学院 护理学院 )
https://doi.org/10.37155/2717-5650-0303-39Abstract
目的: 评价以人为本的护理对认知症患者的效果。 方法: 计算机检索中国知网、万方、维普、中国生 物医学文献服务系统、 PubMed、 Web of Science、 Embase、 Cochrane Library数据库中关于以人为本的护理干预认知 症患者的随机对照试验,检索时限为建库至2021年7月。应用Excel提取文献的基本信息,采用Cochrane Handbook for Systematic Reviews of Interventions-version 5.1.0中的偏倚风险评估工具进行文献质量评价,采用Revman 5.3进行统计 分析,采用GRADE pro对证据进行定量评级,采用Egger线性回归分析对文献进行发表偏倚检验并通过单因素 Meta回 归分析探讨文献异质性来源。 结果: 本研究共纳入10篇随机对照试验。 Meta分析结果显示:与对照组相比,以人为 本的护理可以减少认知症患者激越[SMD = -1.04, 95%CI(-1.99, -0.08), P = 0.03]、精神行为症状 [SMD = 0.67, 95%CI(0.25, 1.10), P = 0.002]及抑郁 [SMD = 0.17, 95%CI(0.01, 0.34), P = 0.04],并能改善患者生活质量 [SMD = 1.25, 95%CI(0.41, 2.10), P = 0.003];与短期干预 [SMD = 0.73, 95%CI(0.04, 1.43), P = 0.04]相比,长期干预 [SMD = 2.02, 95%CI(0.38, 3.67), P = 0.02]更有益于提升患者生活质量;与以人为本标准化干预模式 [SMD = 1.33, 95%CI(0.49, 2.17), P = 0.002]相比,个性化的活动形式[SMD = 1.19, 95%CI(0.83, 1.55), P < 0.00001]更有益于提 升患者生活质量。 结论: 以人为本的护理能减少认知症患者的激越、精神行为症状及抑郁情绪,并能改善患者生活质 量,对提升认知症患者生存质量有积极作用。
Keywords
认知症;以人文本;护理; Meta分析;生活质量;循证Full Text
PDFReferences
report 2015: the global impact of dementia. https://www.alz.
co.uk/research/ world-report-2015 (accessed June 1, 2016).
[2]董晓欣,孙统达,屠杰,等.失智老人照护需求模式影
响因素分析[J].卫生经济研 究,2018(06):30-34.
[3]Holopainen A, Siltanen H, Pohjanvuori A, et al.
Factors Associated with the Quality of Life of People with
Dementia and with Quality of Life-Improving Interventions:
Scoping Review. Dementia (London). 2019;18(4):1507-1537.
[4]Farina N, Page TE, Daley S, et al. Factors associated
with the quality of life of family carers of people with
dementia: A systematic review. Alzheimers Dement.
2017;13(5):572-581.
[5]李海员,杨阳,严峰,等.机构照料者对痴呆患者生活
质量评价[J].中国老年学杂志,2021,41(15):3356-3359.
[6]Moyle W, Bowers B. Quality of life: dementia and
dignity. Int J Older People Nurs. 2010;5(3):227.
[7]刘敏,张惠实.非药物治疗对阿尔茨海默病患者情绪及
生活质量的影响[J].中国老年学杂志,2017,37(07):1768-1770.
[8]Fazio S, Pace D, Flinner J, Kallmyer B. The
Fundamentals of Person-Centered Care for Individuals With
Dementia. Gerontologist. 2018;58(suppl_1):S10-S19.
[9]Chenoweth L, King MT, Jeon YH, et al. Caring for
Aged Dementia Care Resident Study (CADRES) of personcentred care, dementia-care mapping, and usual care in
dementia: a cluster-randomised trial [published correction
appears in Lancet Neurol. 2009 May;8(5):419]. Lancet
Neurol. 2009;8(4):317-325.
[10]Ridder HM, Stige B, Qvale LG, et al. Individual
music therapy for agitation in dementia: an exploratory
randomized controlled trial. Aging Ment Health.
2013;17(6):667-678.
[11]Rokstad AM, Røsvik J, Kirkevold Ø, et al. The effect
of person-centred dementia care to prevent agitation and
other neuropsychiatric symptoms and enhance quality of life
in nursing home patients: a 10-month randomized controlled
trial. Dement Geriatr Cogn Disord. 2013;36(5-6):340-353.
[12]Chenoweth L, Forbes I, Fleming R, et al. PerCEN:
a cluster randomized controlled trial of person-centered
residential care and environment for people with dementia. Int
Psychogeriatr. 2014;26(7):1147-1160[13]Hilgeman MM, Allen RS, Snow AL, et al. Preserving
Identity and Planning for Advance Care (PIPAC): preliminary
outcomes from a patient-centered intervention for individuals
with mild dementia. Aging Ment Health. 2014;18(4):411-424.
[14]Dichter MN, Quasdorf T, Schwab CG, et al.
Dementia care mapping: effects on residents’ quality of life
and challenging behavior in German nursing homes. A quasiexperimental trial. Int Psychogeriatr. 2015;27(11):1875-1892.
[15]Amieva H, Robert PH, Grandoulier AS, et al. GrouP
and individual cognitive therapies in Alzheimer’ s disease: the
ETNA3 randomized trial. Int Psychogeriatr. 2016;28(5):707-717.
[16]李婉妮,闫菊娥,姚婕,等.医护一体人文关怀对老年
轻度认知功能障碍患者影响的相关研究[J].中国医学伦理
学,2016,29(05):833-835.
[17]Ballard C, Corbett A, Orrell M, et al. Impact of
person-centred care training and person-centred activities
on quality of life, agitation, and antipsychotic use in people
with dementia living in nursing homes: A cluster-randomised
controlled trial. PLoS Med. 2018;15(2):e1002500.
[18]陈少英,梁柳宁,陈苑华,等.人文关怀干预模式
在老年痴呆患者中的干预效果研究[J].当代护士(上旬
刊),2020,27(10):121-123.
[19]秦玉菊,黄金.构建以人为本和谐的护患关系[J].中
华现代护理杂志,2008(02):174-176.
[20]陆燕红.老年痴呆患者的人文关怀护理[J].当代护
士(中旬刊),2015(05):78-80.
[21]张薇,李婷,丁子晨,等.论对老年痴呆患者实施人文
关怀[J].中国医学伦理学,2018,31(03):342-345.
[22]Janzen S, Zecevic AA, Kloseck M, et al. Managing
agitation using nonpharmacological interventions for seniors with
dementia. Am J Alzheimers Dis Other Demen. 2013;28(5):524-
532.
[23]Gutzmann H, Qazi A. Depression associated with
dementia. Z Gerontol Geriatr. 2015;48(4):305-311
Copyright © 2022 宫 晶,李景余,孙亚楠,丁良成,吕慧静,臧丽丽,孟庆慧 Publishing time:2022-05-31
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