维持性血液透析患者跌倒发生率及影响因素的Meta分析

A Meta-analysis about the incidence and influencing factors of falling in maintenance hemodialysis patients

目的通过Meta分析系统评价维持性血液透析(maintenance hemodialysis,MHD)患者跌倒的发生率及影响因素。方法计算机检索Web of Science、the Cochrane Library、EMbase、PubMed、中国生物医学数据库(CBM)、中国知网(CNKI)、维普数据库和万方数据库关于维持性血液透析跌倒发生率及影响因素的研究。检索时间为建库至2021年4月,利用Stata 12.0和Revman 5.3软件对符合纳排标准的文献进行系统评价。结果纳入6项横断面研究,5项队列研究和1项病例对照研究,共2656位患者。Meta分析结果显示,维持性血液透析患者跌倒的总体发生率及95%CI为25%(0.19,0.30)。各危险因素的OR或SMD及95%CI为:高血压1.50(0.84,2.67)、透析中低血压2.12(1.65,2.72)、糖尿病2.49(1.96,3.16)、衰弱3.15(2.01,4.92)、抑郁4.07(2.29,7.23)、外周血管疾病7.49(1.57,35.67)、使用辅助器械3.34(2.10,5.33)、年龄0.39(0.16,0.61)、透析龄0.25(0.05,0.45)、保护因素为血红蛋白-0.43(-0.61,-0.26)。结论维持性血液透析患者跌倒的危险因素众多,应尽早进行MHD患者跌倒风险评估并行早期预防和干预。

Objective To systematically evaluate the incidence and risk and protective factors of falling in maintenance hemodialysis patients(MHD)by Meta-analysis.Methods The data base,such as Web of Science,the Cochrane Library,EMbase,PubMed,CBM,CNKI,VIP and Wanfang were searched for the studies about the incidence and influencing factors of falling in MHD patients before April 2021,and the literature were systematically evaluated whether met the criteria for inclusion by using Stata12.0 and Revman5.3 software.Results 6 cross-sectional studies,5 cohort studies and 1 case-control study were included,with a total of 2656 patients.Meta-analysis showed that the overall incidence of falling in MHD patients and the 95%CI was 25%(0.19,0.30).The OR or SMD and 95%CI of each risk factor:hypertension 1.50(0.84,2.67),dialysis hypotension 2.12(1.65,2.72),diabetes 2.49(1.96,3.16),frailty 3.15(2.01,4.92),depression 4.07(2.29,7.23),peripheral vascular disease 7.49(1.57,35.67),use of auxiliary equipment 3.34(2.10,5.33),age 0.39(0.16,0.61),dialysis age 0.25(0.05,0.45),protective factor was hemoglobin-0.43(-0.61,-0.26).Conclusion There are many risk factors for falling in MHD patients.Fall risk assessment in patients with MHD should be carried out as soon as possible and early prevention and intervention should be performed.