经皮冠状动脉介入术后患者当日出院安全性的Meta分析

目的 系统评价护士主导的经皮冠状动脉介入术后患者当日出院的短期及长期效果,为患者当日出院的安全性提供循证依据。方法 计算机检索中英文数据库中有关经皮冠状动脉介入术后患者当日出院的随机对照研究,检索时限为建库至2020年1月9日。采用RevMan 5.2进行Meta分析。结果 最终纳入10项随机对照试验,共3 908例患者,其中试验组1 844例,对照组2 064例。结果显示,与住院患者相比,经皮冠状动脉介入术后患者当日出院24 h心脏不良事件发生率RR=0.28,95%CI（0.05,1.64）,Z=1.42,P=0.16]、24 h总体不良事件发生率RR=0.67,95%CI（0.17,2.68）,Z=0.57,P=0.57]、30 d心脏不良事件发生率RR=0.83,95%CI（0.43,1.58）,Z=0.57,P=0.57]、30 d总体不良事件发生率RR=0.94,95%CI（0.71,1.26）,Z=0.40,P=0.69]、30 d再入院率RR=1.12,95%CI（0.76,1.66）,Z=0.57,P=0.57]、1年心脏不良事件发生率RR=1.03,95%CI（0.76,1.40）,Z=0.19,P=0.85]、1年总体不良事件发生率RR=0.98,95%CI（0.76,1.25）,Z=0.19,P=0.85]均无统计学意义,但当日出院降低了医疗费用,多数患者倾向于当日出院,但患者出院准备度不足。结论 经皮冠状动脉介入术后患者当日出院不会增加患者短期及长期不良事件的发生率,未来可在门诊特定患者群体中开展更多实证研究。

Short-term and long-term clinical outcomes of same day discharge after percutaneous coronary intervention in patients：a systematic review and meta-analysis

Objective To systematically assess short-termed and long-termed clinical outcomes of same day discharge after percutaneous coronary intervention（PCI）. Methods The Cochrane Library, Wiley online library, PubMed and EMBASE et al databases were searched for randomized control trials comparing same day discharge and overnight stay in the hospital after PCI. RevMan 5. 2 was used as the statistical software. Results 10 randomized control trials with a total number of 3 908 patients （1 844 patients were discharged on the same day and 2064 patients stayed overnight in the hospital） were included. The results showed that, compared with overnight hospitalization, the discharge on the same day after PCI had no significant effect on 24-hour incidence of adverse cardiac events RR=0. 28, 95%CI（0. 05, 1. 64）, Z=1. 42, P=0. 16] , 24-hour overall incidence of adverse cardiac events RR=0. 67, 95%CI（0. 17, 2. 68）, Z=0. 57, P=0. 57] , 30-day incidence of adverse cardiac events RR=0. 83, 95%CI（0. 43, 1. 58）, Z=0. 57, P=0. 57] , 30-day overall incidence of adverse events RR=0. 94, 95%CI（0. 71, 1. 26）, Z=0. 40, P=0. 69] , 30-day readmission rate RR=1. 12, 95%CI（0. 76, 1. 66）, Z=0. 57, P=0. 57] , one-year incidence of adverse cardiac events RR=1. 03, 95%CI（0. 76, 1. 40）, Z=0. 19, P=0. 85] and one-year overall incidence of adverse events RR=0. 98, 95%CI（0. 76, 1. 25）, Z=0. 19, P=0. 85] . The medical expenses were reduced and the patients’ satisfaction was improved, but the patients were not well prepared for discharge. Conclusions Discharge on the same day after PCI does not increase the occurrence of short-term and long-term adverse events. In the future, it can be carried out in the outpatient services for specific patient groups.