摘要
目的系统评价认知行为疗法对维持性血液透析患者抑郁、焦虑和生活质量的影响。方法计算机检索Pub Med、EMbase、Cochrane Central of Registration Controlled Trials(CENTRAL,2016年8期)、Web of Science、CINAHL、Psyco INFO、CBM、CNKI和Wan Fang Data中有关认知行为疗法对维持性血液透析患者抑郁、焦虑和生活质量影响的随机对照试验(RCT),检索时限均为建库至2016年9月1日。由2名研究员独立筛选文献、提取资料、评价纳入研究的偏倚风险并进行交叉核对后,采用Rev Man 5.3软件进行Meta分析。结果共纳入14个RCT,包括1 492例患者。Meta分析结果显示,认知行为疗法在干预≥2个月时能够改善维持性血液透析患者的抑郁[SMD=–0.85,95%CI(–0.96,–0.74),P<0.000 01]和焦虑[SMD=–1.16,95%CI(–1.37,–0.94),P<0.000 01],提高患者的生活质量[SMD=0.88,95%CI(0.21,1.56),P=0.010];而干预不足2个月时,认知行为疗法组与对照组相比,抑郁和焦虑改善无显著性差异(P>0.05)。结论认知行为疗法干预≥2个月时对改善维持性血液透析患者的抑郁、焦虑和提高生活质量具有较好的效果,但不足2个月时效果不明显。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。
Objective To systematically evaluate the effects of cognitive behavioral therapy （CBT） on improving depression, anxiety and quality of life in patients with maintenance hemodialysis （MHD）. Methods We searched PubMed, EMbase, CENTRAL （Issue 8, 2016）, Web of Science, CINAHL, PsycoINFO, CBM, CNKI and WanFang Data from inception to Sep. 1st, 2016, to collect randomized controlled trials （RCTs） which studied the effects of CBT on improving depression, anxiety and quality of life in patients with MHD. Literature screening, data extraction, and the risk of bias assessment of all eligible studies were conducted by two reviewers independently. Then, meta-analysis was conducted using RevMan 5.3 software. Results A total of 14 RCTs involving 1 492 patients were included. The results of meta-analysis showed that CBT could significantly improve the depression （SMD=-0.85, 95%CI -0.96 to -0.74, P〈0.000 01）,anxiety （SMD=-1.16, 95%CI -1.37 to -0.94, P〈0.000 01）, and quality of life （SMD=0.88, 95%CI 0.21 to 1.56, P=0.010） of MHD patients after 2 months＇ intervention; however, these effects were not been found within 2 months＇ intervention （all P values〉0.05）. Conclusion CBT is efficacious in improving MHD patients＇ depression, anxiety and quality of life after 2 months＇ intervention, while these effects within 2 months are still not certain. Because of the limitation of quantity and quality of included studies, more high-quality studies are needed to confirm the above conclusion.
作者
李红
王浪
赵丽
谢兰添
陈华更
庞晓丽
LI Hong WANG Lang ZHAO Li XIE Lantian CHEN Huageng PANG Xiaoli(Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China Tianjin Huanhu Hospital, Tianjin 300350, P.R.China School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China)
出处
《中国循证医学杂志》
CSCD
2017年第2期152-161,共10页
Chinese Journal of Evidence-based Medicine
关键词
认知行为疗法
肾透析
抑郁
焦虑
生活质量
系统评价
Meta分析
随机对照试验
Cognitive behavioral therapy
Renal dialysis
Depression
Anxiety
Quality of life
Systematic review
Meta-analysis
Randomized controlled trial
