营养支持预防老年髋部骨折术后低蛋白血症效果的Meta分析

Effect of nutritional support to prevent hypoproteinemia in elderly hip fractures:a Meta-analysis

目的通过Meta分析评价营养支持对老年髋部骨折患者术后低蛋白血症的预防效果。方法计算机检索关于营养支持预防老年髋部骨折患者术后低蛋白血症的随机对照临床试验(Randomized Controlled Trial,RCT),运用Rev Man 5.3软件对纳入文献进行Meta分析。结果共纳入13篇文献,包括患者1520例,观察组768例,对照组752例。Meta分析结果显示:①主要结局指标:与常规饮食组相比,营养支持可提高髋部骨折患者术后血清白蛋白[MD=2.80,95%CI(1.59,4.01),P<0.01]、血红蛋白[MD=6.11,95%CI(0.68,11.54),P<0.05]、血清总蛋白[MD=6.33,95%CI(3.17,9.49),P<0.01]、前白蛋白[MD=24.09,95%CI(3.05,45.14),P<0.05];但不能提高转铁蛋白[MD=0.42,95%CI(-0.14,0.97),P>0.05]。②次要结局指标:与常规饮食组相比,营养支持可提高髋部骨折患者术后营养指数、Harris髋关节评分、Barther指数、切口甲级愈合率,降低营养风险,减少住院时间,使患者下床时间提前;但不能减少术后并发症。结论营养支持可预防髋部骨折术后低蛋白血症,其效果优于常规饮食。临床上应及早评估并努力纠正老年髋部骨折患者的营养不良。

Objective To evaluate the preventive effect of nutritional support on postoperative hypoproteinemia in elderly hip fracture patients through Meta-analysis.Methods The computer retrieved the RCT on nutritional support to prevent postoperative hypoproteinemia in elderly patients with hip fracture,and used RevMan 5.3 software to conduct a Meta-analysis of the included literature.Results A total of 13 articles were included,including 1520 patients,768 in the observation group and 752 in the control group.Meta-analysis Results showed:①Main outcome indicators:compared with the conventional diet group,nutritional support can improve postoperative serum albumin in patients with hip fractures[MD=2.80,95%CI(1.59,4.01),P<0.01],Hemoglobin[MD=6.11,95%CI(0.68,11.54),P<0.05],total serum protein[MD=6.33,95%CI(3.17,9.49),P<0.01],prealbumin[MD=24.09,95%CI(3.05,45.14),P=0.05];cannot improve transferrin[MD=0.42,95%CI(-0.14,0.97),P>0.05].②Secondary outcome indicators:compared with the conventional diet group,nutritional support can improve the postoperative nutrition index,Harris hip score,Barther index,incision grade A healing rate of patients with hip fractures,reduce nutritional risk,and reduce hospitalization time.Make patients get out of bed earlier;cannot reduce postoperative complications.Conclusion Nutritional support can prevent hypoproteinemia after hip fracture,and its effect is better than conventional diet.