早期出院支持策略对脑卒中患者的干预效果的系统评价

摘要

Objective To evaluate the intervention efficacy of early supported discharge ( ESD ) strategy on stroke. Methods Pubmed, Cochrane Central Register of ControlLed Trials, EMBase, Web of Science, CNKI, VIP and Wanfang Data were searched. Quality of eligible evidence was assessed, Data were extracted and analyzed. Results 17 researches were included in the analysis. Multidisciplinary team offered ESD strategy to mild and moderate stroke patients. It was found that both the initial hospitalization time [ MD = 9. 98, 95% CI ( 7. 55, 12. 42 ), P < 0. 00001 ] and total hospitalization time [ MD = 11. 64, 95% CI ( 7. 38, 15. 90 ), P <0. 00001 ] were notably reduced under ESD strategy. Total medical expense per person for ESD group was reduced from 4. 34% to 29. 65% , compared with the control group. No statistical significance was found between ESD group and control group in mortality rate and carer strain ( P >0. 05 ). Conclusion Multidisciplinary ESD strategy may play an active role in the process of health service improvement and is a feasible treatment mode.%目的 客观评价早期出院支持策略对脑卒中患者的干预效果.方法 检索Pubmed、Cochrane临床对照试验中心注册数据库、EMBase、Web of Science、中国学术期刊全文数据库、重庆维普中文科技期刊数据库、万方数据知识服务平台.评价证据质量,提取资料并进行数据分析.结果 共纳入17篇研究论文,由多学科医疗团队对轻、中度脑卒中患者提供早期出院支持策略.脑卒中早期出院支持组首次住院时间[MD＝9.98,95%CI(7.55,12.42),P＜0.00001]和总住院时间显著缩短[MD＝11.64,95%CI(7.38,15.90),P＜0.00001],人均医疗费支出相对于对照组降低4.34%～29.65%.两组患者的病死率和照顾者压力差异无统计学意义(P＞0.05).结论 多学科早期干预支持方案在脑卒中卫生服务提供过程中发挥积极作用,是一种可行的治疗模式.