综合干预对老年痴呆患者家庭照顾者抑郁情绪改善的系统评价

摘要

目的：系统评价综合干预对老年痴呆患者家庭照顾者抑郁情绪的干预效果。方法计算机检索PubMed、中文生物医学文献数据库（ CBM）及中国知网（ CNKI）、万方等全文数据库，检索时限为建库至2014年12月。纳入文献中试验组对老年痴呆患者照顾者实施综合干预，即健康教育＋心理治疗＋技能训练、健康教育＋心理治疗或者健康教育＋技能训练；对照组只做一般护理教育或空白对照。采用RevMan 5.3软件对两组抑郁情绪改善情况进行分析。结果共纳入10篇随机对照试验，769例患者，其中试验组385例，对照组384例。纳入的10篇文献中，均把抑郁状况作为主要的结局指标，但评估方法不同，本研究只对使用抑郁自评量表（ SDS）的7篇文献进行了合并分析。实施干预措施3、6、9、12个月后，试验组SDS评分均低于对照组，差异有统计学意义〔SMD＝-0.76，95％CI （-1.49，-0.03），P ＝0.04；SMD ＝-0.65，95％ CI（-0.85，-0.46），P ﹤0.01；SMD ＝-0.73，95％ CI （-1.02，-0.44），P﹤0.01；SMD＝-0.80，95％CI（-1.08，-0.53），P﹤0.01〕。敏感性分析结果显示，实施干预措施3个月后，试验组和对照组SDS评分比较，差异无统计学意义〔SMD＝-0.69，95％CI（-1.90，0.53），P＝0.27〕，与原结果不一致，稳定性较差。漏斗图显示，散点左右分布不对称，提示存在发表偏倚。结论综合干预措施可以改善老年痴呆患者家庭照顾者的抑郁情绪，但由于受纳入文献质量和数量的限制，有待开展更多高质量、多中心研究加以验证。%Objective To explore the effect of comprehensive intervention on depression of family caregivers of patients with senile dementia through a systematic review. Methods We made a computer-based retrieval in PubMed,CBM,CNKI and Wanfang database with a research time from database establishment to December 2014. Data about the comprehensive intervention on depression of family caregivers of patients with senile dementia of research group were collected, and the interventions included health education+ psychological treatment+skill training,health education+ psychological treatment or health education+ skill training. The control group was only administrated with general education or blank control. RevMan 5. 3 software was employed to conduct analysis on the improvement of depression of the two groups. Results We included 10 pieces of literature with randomized controlled trial concerning 769 patients,among which 385 were in research group and 384 were in control group. In all 10 randomized controlled trails,depression status was taken as the primary outcome indicator,while the measure methods were different. Therefore,we conducted combined analysis on only 7 pieces of literature. After intervention for 3 months,6 months,9 months and 12 months,research group was lower than control group in SDS score〔SMD= -0. 76,95%CI( -1. 49,-0. 03),P =0. 04;SMD = -0. 65,95%CI( -0. 85,-0. 46),P ﹤0. 01;SMD = -0. 73,95%CI ( -1. 02,-0. 44),P﹤0. 01;SMD= -0. 80,95%CI( -1. 08,-0. 53),P﹤0. 01〕. Sensitivity analysis showed that, after intervention for 3 months,research group and control group were not significantly different in the score of SDS〔SMD =-0. 69,95% CI ( - 1. 90, 0. 53 ), P = 0. 27〕, which was inconsistent with the previous results, indicating poor stability. Funnel analysis showed that the scatter points were asymmetric, which indicated the publication bias existed. Conclusion Comprehensive intervention measure can alleviate the depression of family caregivers of patients with senile dementia. However,due to the limitation of the quality and quantity of included literature,more high-quality and multi-center research need to be made in order to verify the results.