认知行为疗法预防老年髋部骨折术后患者认知功能障碍的Meta分析

Meta analysis of cognitive behavioral therapy in preventing cognitive dysfunction in elderly patients after hip fracture surgery

目的评价认知行为疗法在预防老年髋部骨折术后患者认知功能方面的疗效。方法计算机检索PubMed、Cochrane Library、Embase、中国知网、万方医学网和维普数据库,检索纳入应用认知行为疗法预防老年髋部骨折患者术后认知功能障碍的随机对照试验,检索时限为从建库至2021年11月。纳入试验对照组给予常规护理措施,观察组在此基础上给予认知行为疗法。由两名评价者根据纳入排除标准独立筛选文献、提取资料后,采用Cochrane 5.1.0版手册中的RCT评价标准对纳入研究进行质量评估,采用RevMan5.3软件进行Meta分析。结果最终共纳入8项随机对照试验,合计565例受试者。Meta分析结果显示,简易智能量表(MMSE)[MD=2.42,95%CI(1.58~3.26),P<0.01],正念注意觉知量表(MAAS)[MD=3.41,95%CI(1.97~4.85),P<0.01]显示认知功能方面明显优于对照组。亚组分析结果显示:(1)年龄:平均年龄越大,患者术后认知功能障碍的风险越大,认知功能评分量表的评分越高[SMD=0.13,95%CI(-0.08~0.35),P=0.10]。(2)术后认知功能评分时间:术后第三天对患者进行认知功能评估,评分结果异质性大,[SMD=1.24,95%CI(0.97~1.52),P=0.006]。结论运用认知行为疗法能够有效降低老年髋部骨折术后患者认知功能障碍的风险。但受纳入研究数量限制,研究结论尚需开展大样本、多中心的随机对照试验研究加以验证。

Objective To evaluate cognitive behavioral therapy in preventing cognitive function of patients with hip bone fracture in old age.Methods Retrieves PubMed,Cochrane Library,Embase,CNKI,Wan fang Date,COVIP,incorporating randomized controlled trials for patients with cognitive behavioral therapy to prevent hip fractures.After the two evaluators were filtered according to the inclusion criteria independent screening,after extracting the information,the Cochrane evaluation criteria were used to carry out the quality assessment of the inclusion study,and the revman5.3 software was used for Meta analysis.Results 8 randomized controlled trials were finally included,and 565 subjects were included.Meta analysis results show that simple intelligent table(MMSE)[MD=2.42,95%Cl(1.58~3.26),P<0.01],Justice to pay attention to awareness(MAAS)are significantly better than the control group[MD=3.41,95%CI(1.97~4.85),P<0.01].The results of subgroup showed that the average age of the subject:(1)the larger the average age,the greater the risk of postoperative cognitive dysfunction,the higher the score of cognitive function evaluation scale[SMD=0.13,95%Cl(-0.08~0.35),P=0.10].(2)The third day after surgery,the patient’s cognitive function assessment was performed on the third day after surgery,and the evaluation results were not accurate[SMD=1.24,95%Cl(0.97~1.52),P=0.006].Conclusion Applying cognitive behavioral therapy can effectively prevent the patient’s cognitive dysfunction after hip bone perfusion.However,the number of studies incurred in the study,the research conclusion is still needed to conduct a large sample,and the multi-center randomized controlled trial is verified.