间歇经口管饲对老年吞咽障碍患者干预效果的meta分析

Meta-analysis of the intervention effect of intermittent oral catheterization on elderly patients with dysphagia

目的评价间歇经口管饲(IOC)对老年吞咽障碍患者的吞咽功能、营养状况、并发症的影响。方法检索Embase、PubMed、The Cochrane Library、Web of Science、CINAHL、中国知网、万方、CBM数据库,检索时限为1985年1月至2022年7月。由2名研究者独立筛选文献、资料提取和质量评价,采用RevMan 5.4软件进行统计分析,并采用GRADEpro 3.6软件进行证据强度论证。结果共纳入11篇文献,1209例患者。meta分析结果显示,IOC能提高患者的吞咽功能[OR=3.83,95%CI(2.52,5.84),P<0.00001],改善血清白蛋白[MD=4.38,95%CI(2.52,6.24),P<0.00001]、血清总蛋白[MD=4.58,95%CI(1.25,7.91),P=0.007]等营养指标,降低吸入性肺炎发生率[OR=0.38,95%CI(0.16,0.93),P=0.03],GRADE证据等级为极低至高级。结论IOC可以提高老年吞咽障碍患者的吞咽功能,改善营养状态,降低吸入性肺炎的发生率,具有较好的临床实践价值,但仍需更多高质量的随机对照研究进行验证。

Objective To evaluate the effects of intermittent oral catheterization(IOC)on swallowing function,nutritional status,and complications in elderly patients with dysphagia.Methods The Embase,PubMed,The Cochrane Library,Web of Science,CINAHL,China National Knowledge Infrastructure,Wanfang,and CBM databases were retrieved,with a retrieval period from January 1985 to July 2022.Two researchers independently screened the literature,extracted data,and evaluated the quality.Statistical analysis was conducted using RevMan 5.4 software,and evidence strength was demonstrated using GRADEpro 3.6 software.Results A total of 11 articles were included,involving 1209 patients.Meta-analysis results showed that IOC can improve patients'swallowing function(OR=3.83,95%CI[2.52,5.84],P<0.00001),improve serum albumin(MD=4.38,95%CI[2.52,6.24],P<0.00001),total serum protein(MD=4.58,95%CI[1.25,7.91],P=0.007),and other nutritional indicators,and reduce the incidence of aspiration pneumonia(OR=0.38,95%CI[0.16,0.93],P=0.03).And their GRADE evidence levels were from extremely low to high.Conclusion IOC can improve swallowing function,improve nutritional status,and reduce the incidence of aspiration pneumonia in elderly patients with dysphagia,which has good clinical practice value.However,more high-quality randomized controlled studies are still needed for validation.