| Objective:The network meta-analysis was used to systematically evaluate the application effects of different postural nursing measures in neonatal respiratory distress syndrome,and to rank them,in order to find the best clinical evidences.Methods:We searched CNKI,Wanfang,VIP,Sinomed,Pub Med,Cochrane Library,Web of science,EMBASE and CINAHL.We searched the randomized controlled trials on the application of different postural nursing in neonatal respiratory distress syndrome from the establishment of the database to January 2021.In this study,the arterial blood oxygen partial pressure and the incidence of adverse events were the main outcome index,and the blood oxygen saturation and mechanical ventilation time were the secondary outcome index.In accordance with the inclusion and exclusion criteria,we have completed document screening,quality evaluation and data extraction.We used Stata15.1 software to conduct network meta-analysis and probabilistic ranking of the outcome index,evaluate the consistency of the studies,and draw a comparison-correction funnel diagram to detect the small sample effect.Results:1.Finally,33 articles were included,including 2146 newborns,involving a total of six posture nursing interventions(supine,prone,left,right,1/4 prone,and alternate position).2.For increasing the partial pressure of arterial blood oxygen,the prone position is better than the supine position nursing,and the alternate nursing and supine position nursing is better than the supine position nursing,there were statistically significant of the differences;the left side,right side,and supine position nursing have no statistically significant.The order of probability is: prone position(SUCRA=95.8)>alternate position(SUCRA=71.9)> supine position(SUCRA=33.1)>right side position(SUCRA=30.7)>left side position(SUCRA=18.6).3.To reduce the incidence of adverse events,the alternate lying position nursing is better than the supine position nursing,and the prone position nursing is better than the supine position nursing.There were statistically significant of the differences.The order of probability is: alternating lying position(SUCRA=79.6)>right lying position(SUCRA=61.1)>prone position(SUCRA=60.8)>left lying position(SUCRA=60.8)>supine position(SUCRA=3.9).4.For improving blood oxygen saturation,1/4 prone position is better than supine position nursing,prone position is better than supine position,alternate lying position is better than supine position,there were statistically significant of the differences.The probability sequence is: 1/4 prone position(SUCRA=86.7)> prone position(SUCRA=74.3)>left side position(SUCRA=48.5)>alternate position(SUCRA=42.5)>right side position(SUCRA=37.7)>Supine position(SUCRA=10.2).5.To shorten the time of mechanical ventilation,the prone position is better than the supine position nursing,and the alternate and supine position nursing is better than the supine position nursing.There were statistically significant of the differences.The probability order is: prone position(SUCRA=91.1)>alternate position(SUCRA=58.9)> supine position(SUCRA=0.0).Conclusion:1.Compared with supine position nursing,prone position nursing and alternate position nursing can increase the arterial blood oxygen partial pressure,reduce the incidence of adverse events,increase blood oxygen saturation and shorten the time of mechanical ventilation in children with NRDS.2.In increasing arterial partial pressure of oxygen,in terms of increasing blood oxygen saturation,in terms of shortening the time of mechanical ventilation,the prone position nursing is better than the alternate position nursing and supine position nursing.3.In reducing the incidence of adverse events,the alternate position is better than the prone position.4.In terms of improving blood oxygen saturation,1/4 prone position is better than prone position,alternate position and other positions.5.The effects of left and right-side positions on children with NRDS need to be confirmed by more randomized controlled studies.6.In clinical practice,nursing workers and decision makers should pay sufficient attention and attention to the postural nursing of children with NRDS,and actively promote the formulation and implementation of postural nursing programs to improve the quality of nursing.7.In future research,we look forward to the development of more high-quality,multi-center,large-sample randomized controlled studies to compare the effects of different positions and the implementation of different positions in an all-round way,to provide more evidence-based basis for NRDS body position nursing. |
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