王嘉孺，樊杭，张瑛，谭思连，邓锦欣，黄乐炜，赖春泓，杨士博，杨永

引用本文： 王嘉孺，樊杭，张瑛，谭思连，邓锦欣，黄乐炜，赖春泓，杨士博，杨永.非药物干预对老年高血压睡眠障碍影响的网状Meta分析[J].循证护理,2023,9(21):3801-3810

摘要： 目的：运用网状Meta分析评价非药物干预措施减轻老年高血压睡眠障碍的效果。方法：检索中国知网（CNKI）、万方数据库（WanFang Database）、维普数据库（VIP）、中国生物医学文献数据库、PubMed、Web of Science、the Cochrane Library、EMbase数据库公开发表的非药物干预方法减轻老年高血压睡眠障碍效果的临床随机对照试验（RCT）,检索时限为自建库至2022年6月1日。由2名研究者独立进行质量评价和资料提取，若出现分歧与第3名研究者讨论解决。筛选符合标准的研究，采用RevMan 5.3中的偏倚风险评估工具对文献进行质量评价；采用Stata 17.0软件进行网状Meta分析。结果：共纳入17个随机对照试验，包括1 558例病人，涉及13种非药物干预方法。匹兹堡睡眠质量指数（PSQI）的网状Meta分析结果显示：在改善老年高血压病人睡眠质量方面，耳穴压豆、电项针、耳穴压豆+音乐疗法、全息头部刮痧、正念训练优于常规护理，差异有统计学意义；结果排序图显示：全息头部刮痧＞耳穴压豆+音乐疗法＞电项针＞耳穴压豆＞认知行为干预＞正念疗法＞足浴+穴位按摩＞八段锦+五行音乐疗法＞健康宣教＞八段锦＞虚拟现实技术+生物反馈＞穴位按摩＞常规护理。血压值的网状Meta分析结果显示：耳穴压豆优于常规护理，差异有统计学意义；结果排序图显示：收缩压方面，耳穴压豆＞虚拟现实技术+生物反馈＞八段锦+五行音乐疗法＞全息头部刮痧＞八段锦＞健康教育＞常规护理；舒张压方面，耳穴压豆＞健康教育＞虚拟现实技术+生物反馈＞全息头部刮痧＞八段锦＞常规护理。结论：当前证据显示，纳入的13种干预措施中全息头部刮痧在改善老年高血压病人睡眠障碍方面为最佳干预方案，耳穴压豆在降压和改善睡眠两方面都具有一定优势。本研究受纳入研究数量和质量限制，结论尚需开展更多高质量研究予以验证。

关键词： 老年高血压；睡眠障碍；非药物干预；网状Meta分析；循证护理

课题： 2022年度广西高校中青年教师科研基础能力提升项目（自然科学类），编号：2022KY1670；2022年广西中医药大学校级科研项目，编号：2022MS020；2022年广西中医药大学赛恩斯新医药学院校级科研项目，编号：2022MS012；2022年广西中医药大学大学生创新创业训练计划项目（自治区级），编号：S202210600119

WANG Jiaru,FAN Hang,ZHANG Ying,TAN Silian,DENG Jinxin,HUANG Lewei,LAI Chunhong,YANG Shibo,YANG Yong

Abstract Objective:To evaluate the effect of non-pharmaceutical interventions on reducing sleep disturbance in elderly hypertensive patients using network Meta-analysis.Methods:Clinical randomized controlled trials (RCTs) related to the effect of non-pharmaceutical intervention methods reducing sleep disturbance in elderly hypertensive patients were retrieved from CNKI,WanFang Database,VIP ,CBM,PubMed,Web of Science,the Cochrane Library,and EMbase databases from the establishment of databases to June 1,2022. Two researchers independently performed the quality evaluation and data extraction,and any disagreements were discussed with the third researcher to resolve them. The studies meeting the criteria were screened;the quality of the literature was evaluated by the risk of the bias assessment tool in RevMan 5.3;the Stata 17.0 software was used to conduct network Meta-analysis.Results:A total of 17 RCTs were included,involving 1 558 patients and 13 non-pharmaceutical intervention methods. The network Meta-analysis results of Pittsburgh Sleep Quality Index (PSQI) showed that in improving the sleep quality of elderly hypertensive patients,auricular pressure beans,electric neck acupuncture,auricular pressure beans + music therapy,holographic head scraping,and mindfulness training are superior to routine nursing,and the difference was statistically significant;the result ranking graph displayed that,holographic head scraping>auricular pressure beans + music therapy>electric neck acupuncture>auricular pressure beans>cognitive behavioral intervention >mindfulness therapy>foot bath + acupoint massage >Baduanjin + music therapy>health education>Baduanjin>virtual reality technology + biofeedback>acupoint massage>routine nursing. The network Meta-analysis results of blood pressure values showed that auricular point pressure beans are superior to routine care,and the difference is statistically significant;the result ranking graph displayed that,in terms of systolic blood pressure,auricular pressure beans>virtual reality technology+biofeedback>Baduanjin+music therapy >holographic head scraping>Baduanjin>health education>routine nursing;in terms of diastolic blood pressure,auricular pressure beans>health education>virtual reality technology+biofeedback>holographic head scraping>Baduanjin>routine nursing.Conclusions:The existing evidence showed that among the 13 included interventions,holographic head scraping was the best intervention for improving sleep disorders in elderly hypertensive patients,and auricular pressure beans had certain advantages in reducing blood pressure and improving sleep quality. This study is limited by the quantity and quality of the included studies,and the above conclusions need to be verified by more high-quality studies.

Keywords elderly hypertension;sleep disturbance;non-pharmaceutical intervention;network Meta-analysis;evidence-based nursing

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