脑卒中患者营养不良相关因素的系统评价

Influencing factors of malnutrition in stroke patients:a systematic evaluation and Meta-analysis

目的通过系统评价明确脑卒中患者营养不良的影响因素,为脑卒中患者营养不良的预防控制提供参考依据。方法检索中国知网、万方数据知识服务平台、维普期刊全文数据库、中国生物医学文献数据库、Embase、PubMed、Web of Science数据库,收集关于脑卒中患者营养不良影响因素的研究文献,检索时限为建库至2021年9月。由两名研究人员独立进行文献筛选、评价文献质量及提取数据,采用Comprehensive Meta Analysis V2软件进行Meta分析。结果共纳入48篇文献,Meta分析结果显示,年龄(SMD=0.50,95%CI:0.35~0.66)、体质指数(SMD=-1.11,95%CI:-1.57~-0.64)、美国国立卫生院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(SMD=0.65,95%CI:0.52~0.77)、住院时长(SMD=0.45,95%CI:0.29~0.62)、血清白蛋白(SMD=-0.71,95%CI:-0.98~-0.44),以及房颤史、卒中史、入院改良Rankin量表(modified Rankin scale,MRS)>3分、抑郁、意识障碍、感染、肺炎、腹泻、吞咽障碍、认知障碍、鼻饲(均RR>1)是脑卒中患者营养不良的危险因素(均P<0.05);性别是保护性因素(RR<1,P<0.05)。结论脑卒中患者营养不良受多种因素的影响,医护人员应重视并及时识别这些影响因素,并尽早采取针对性防护措施,以减少营养不良对患者康复和预后的负性影响。

Objective To explore the influencing factors of malnutrition in stroke patients based on systematic evaluation and meta-analysis,so as to provide reference for the prevention and control of malnutrition.Methods Databases such as CNKI,Wanfang Data,VIP,Chinese Biomedical Literature Database,Embase,PubMed and Web of Science databases were searched for the studies on the factors affecting malnutrition in stroke patients from the inception to September 2021.Two researchers independently conducted literature screening,evaluation of literature quality and data extraction,using Comprehensive Meta Analysis V2 for meta-analysis.Results A total of 48 literatures were included.The analysis showed that the risk factors for malnutrition in stroke patients included age(SMD=0.50;95%CI:0.35,0.66),body mass index(SMD=-0.71;95%CI:-0.98,-0.44),National Institutes of Health Stroke Scale(NIHSS)score(SMD=0.65;95%CI:0.52,0.77),length of hospital stay(SMD=0.45;95%CI:0.29,0.62),serum albumin(SMD=-1.11;95%CI:-1.57,-0.64)and history of atrial fibrillation,stroke history,admission modified Rankin scale(MRS)>3,depression,disturbance of consciousness,infection,pneumonia,diarrhoea,dysphagia,cognitive impairment,nasal feeding(all RR>1)(all P<0.05).It was found that the gender was a protective factor(RR<1,P<0.05).Conclusions Malnutrition in stroke patients is affected by many factors.Medical staff should pay attention to and identify the factors timely,and take targeted protective measures as soon as possible to reduce the negative factors that affect the nutrition in rehabilitation and prognosis of patients.