老年患者吸入性肺炎危险因素的Meta分析

Meta-analysis of risk factors for aspiration pneumonia in elderly patients

目的系统评价老年患者吸入性肺炎(AP)的危险因素,为临床早期预防AP提供循证依据。方法系统检索中国知网、万方数据库、维普网、中国生物医学文献数据库、Cochrane Library、PubMed、Web of Science、Embase等中英文数据库,检索时限为建库至2021年12月31日。进行文献质量评价后,使用RevMan 5.4.1软件进行Meta分析。结果共纳入20篇文献,包括25项相关危险因素。Meta分析结果显示,高龄(MD=3.71,95%CI:2.34~5.09,P<0.01)、男性(OR=1.38,95%CI:1.03~1.58,P<0.01)、慢性基础疾病(OR=0.13,95%CI:0.04~0.23,P<0.01)、帕金森(OR=13.45,95%CI:1.22~148.88,P<0.05)、胃食管反流(OR=2.47,95%CI:2.03~3.00,P<0.01)、误吸史(OR=22.77,95%CI:3.95~131.36,P<0.01)、低蛋白血症(OR=6.44,95%CI:3.55~11.66,P<0.01)、吞咽障碍(OR=2.40,95%CI:1.48~3.88,P<0.01)、意识障碍(OR=3.39,95%CI:2.18~5.27,P<0.01)、咳嗽障碍(OR=9.62,95%CI:2.84~32.60,P<0.01)、认知障碍(OR=3.50,95%CI:1.06~11.51,P<0.05)、使用镇静药(OR=3.46,95%CI:2.26~5.30,P<0.01)、使用抑酸剂(OR=3.42,95%CI:1.32~8.84,P<0.05)、鼻饲(OR=2.02,95%CI:1.41~2.89,P<0.01)、吸痰(OR=3.01,95%CI:2.54~3.57,P<0.01)、长期卧床(OR=5.17,95%CI:3.39~7.87,P<0.01)、体位不当(OR=2.99,95%CI:1.48~6.05,P<0.01)是老年患者AP的危险因素。结论老年患者AP并非单一因素作用的结果,而是由个体因素、疾病相关因素、治疗相关因素等多种因素综合作用的结果。

Objective To systematically evaluate the risk factors of aspiration pneumonia(AP)in elderly patients,so as to provide evidence-based basis for clinical early prevention of AP.Methods We systematically searched Chinese and English databases such as China National Knowledge Infrastructure(CNKI),WanFang Data,VIP,China Biomedical Literature Database,Cochrane Library,PubMed,Web of Science,Embase.The search time limit was from the establishment of the database to December 31,2021.After quality evaluation,RevMan 5.4.1 software was used for Meta-analysis.Results A total of 20 articles were included,including 25 related risk factors.Meta-analysis results showed that the elderly[MD=3.71,95%CI(2.34,5.09),P<0.01],male[OR=1.38,95%CI(1.03,1.58),P<0.01],chronic underlying disease[OR=0.13,95%CI(0.04,0.23),P<0.01],Parkinson's disease[OR=13.45,95%CI(1.22,148.88),P<0.05],gastroesophageal reflux[OR=2.47,95%CI(2.03,3.00),P<0.01],history of aspiration[OR=22.77,95%CI(3.95,31.36),P<0.01],hypoalbuminemia[OR=6.44,95%CI(3.55,11.66),P<0.01],dysphagia[OR=2.40,95%CI(1.48,3.88),P<0.01],disorder of consciousness[OR=3.39,95%CI(2.18,5.27),P<0.01],cough disorder[OR=9.62,95%CI(2.84,32.60),P<0.01],cognitive disorder[OR=3.50,95%CI(1.06,11.51),P<0.05],use of sedatives[OR=3.46,95%CI(2.26,5.30),P<0.01],use of acid suppressants[OR=3.42,95%CI(1.32,8.84),P<0.05],nasal feeding[OR=2.02,95%CI(1.41,2.89),P<0.01],sputum aspiration[OR=3.01,95%CI(2.54,3.57),P<0.01],long-term bed rest[OR=5.17,95%CI(3.39,7.87),P<0.01],and improper posture[OR=2.99,95%CI(1.48,6.05),P<0.01]were risk factors for AP in elderly patients.Conclusions AP in elderly patients is not the result of a single factor,but the result of a combination of individual factors,disease-related factors,treatment-related factors and other factors.