正念认知疗法对脑卒中患者影响的系统评价和Meta分析-现代医学

正念认知疗法对脑卒中患者影响的系统评价和Meta分析

单位：1. 大理大学护理学院, 云南大理 671013;
2. 云南省第三人民医院神经内科, 云南昆明 650011

分类号：R473.74

出版年·卷·期（页码）：2025·53·第二期（162-171）

摘要：

目的：系统评价正念认知疗法对脑卒中患者干预效果的影响。方法：计算机检索Cochrane Library、Web of Science、PubMed、Embase、维普、万方、中国知网、中国生物医学文献数据库，收集建库至2024年4月14日发表的有关正念认知疗法对脑卒中患者影响的随机对照试验。由2名研究者分别审阅摘要和全文并提取资料，使用Cochrane偏倚风险工具对纳入研究的潜在偏倚风险进行评估，统计分析使用RevMan 5.3软件进行。结果：共纳入14篇随机对照试验，共计1 205例脑卒中患者。Meta分析结果显示,正念认知疗法可降低脑卒中患者的焦虑[SMD=-1.66，95%CI(-2.36，-0.97)，P＜0.001]和抑郁水平[SMD=-0.9，95%CI(-1.23，-0.57)，P＜0.001]，提高患者的日常生活自理能力[MD=8.04，95%CI(5.32，10.75)，P＜0.001]、正念水平[SMD=0.8，95%CI(0.3，1.29)，P=0.001]及睡眠质量[MD=-3.51，95%CI(-5.89，-1.14)，P=0.004]，但对患者生活质量的改善不明显[SMD=0.4，95%CI(-0.01，0.82)，P=0.06]。结论：正念认知疗法对脑卒中患者具有显著的益处，具体表现为有效减轻了患者的焦虑与抑郁情绪，显著提升了患者的日常生活自理能力，并促进了正念水平的增强及睡眠质量的优化。然而，在改善患者整体生活质量方面，其效果尚不够显著，有待进一步研究与探讨。

Objective: To systematically evaluate the effects of mindfulness based cognitive therapy on the effectiveness of interventions for stroke patients. Methods: The Cochrane Library, Web of Science, PubMed, Embase, VIP database, Wanfang database and Chinese Biomedical Literature Database were searched by computer for randomized controlled trials(RCTs) published from the establishment of the database to April 14, 2024 on the effects of mindfulness-based cognitive therapy on stroke patients. Two researchers independently screened the abstract and the full text, extracted information and used the Cochrane Risk of Bias tool to evaluate the quality of the included studies, and RevMan 5.3 software was used for statistical analysis. Results: A total of 14 randomized controlled trials with a total of 1 205 stroke patients were included. Meta-analysis showed that mindfulness based cognitive therapy reduced anxiety[SMD=-1.66,95%CI(-2.36,-0.97),P<0.001] and depression levels in stroke patients[SMD=-0.9,95%CI(-1.23,-0.57),P<0.001],improved patients' self-care ability in daily life[MD=8.04,95%CI(5.32,10.75),P<0.001], and mindfulness level[SMD=0.8,95%CI(0.3,1.29),P=0.001] and sleep quality[MD=-3.51,95%CI(-5.89,-1.14), P=0.004], but the improvement of patients' quality of life was not significant[SMD=0.4,95%CI(-0.01,0.82), P=0.06]. Conclusion: Mindfulness based cognitive therapy has significant benefits for stroke patients, which can be seen in the reduction of anxiety and depression, significant improvement of patients' self-care ability in daily life, and the enhancement of mindfulness level and optimization of sleep quality. However, the effect on improving the overall quality of life of patients is not significant, yet further researches are needed.

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