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目的系统评价医生-护士-药师协作改善糖尿病患者心血管危险因素的文献研究。方法计算机检索Cochrane临床对照试验中心注册库、Medline(Ovid SP)、Embase、中国知网、维普、万方数据库,查找医生-护士-药师协作改善糖尿病患者心血管危险因素的随机对照试验(randomized controlled trial,RCT),检索时限截至2016年12月。由2名研究者根据纳入与排除标准独立筛选文献、提取资料并评价质量后,采用Rev Man 5.3.0软件进行Meta分析。结果最终纳入7个RCT,8 109例患者。结果显示:协作组较常规组显著改善患者糖化血红蛋白[SMD=–0.39,95%CI(–0.56,–0.21),P<0.000 1],收缩压[SMD=–0.30,95%CI(–0.43,–0.18),P<0.000 01],舒张压[SMD=–0.37,95%CI(–0.64,–0.11),P=0.006],低密度脂蛋白胆固醇[SMD=–0.11,95%CI(–0.16,–0.06),P<0.000 1],差异有统计学意义。对于患者的病死率和住院率,两组差异无统计学意义(P>0.05)。结论医生-护士-药师协作改善糖尿病患者心血管危险因素较常规组好。其远期疗效有待开展更多高质量、大样本、长期随访的RCT加以验证。
OBJECTIVE: To evaluate the contribution of physician-nurse-pharmacist collaboration in improving cardiovascular risk factors in diabetic patients. Methods Randomized controlled trials (NCTs) of the Cochrane Central Register of Controlled Cochrane, Medline (Ovid SP), Embase, CNKI, VIP, Wanfang Database and Find-doctor-Nurse- trial, RCT), search deadline as of December 2016. Two researchers independently screened literature based on inclusion and exclusion criteria, extracted data, and evaluated quality. Meta-analysis was performed using Rev Man 5.3.0 software. The results eventually included 7 RCTs and 8,109 patients. The results showed that: the cooperative group significantly improved the level of HbA1c (SMD = -0.39,95% CI -0.56, -0.21, P <0.0001), systolic blood pressure (SMD = -0.30, 95% CI -0.43 , -0.18), P <0.000 01], diastolic blood pressure [SMD = -0.37,95% CI (-0.64, -0.11), P = 0.006], low density lipoprotein cholesterol [SMD = -0.11, 95% CI -0.16, -0.06), P <0.000 1], the difference was statistically significant. There was no significant difference between the two groups in the case fatality rate and hospitalization rate (P> 0.05). Conclusion The doctor-nurse-pharmacist collaboratively improved the cardiovascular risk factors in diabetic patients compared with the conventional group. Its long-term efficacy remains to be validated by more high-quality, large-scale, long-term RCTs.