3种营养管理模式在脑卒中吞咽障碍患者中应用效果的meta分析

Meta-analysis of the application effects of three nutritional managementmodels in stroke patients with dysphagia

目的探讨不同的营养管理模式在脑卒中吞咽障碍患者中的应用效果。方法计算机检索PubMed、Web of Science、Embase、the Cochrane Library、中国知网、中国生物医学文献数据库、维普和万方数据库,搜集建库至2023年7月发表的有关脑卒中吞咽障碍患者营养管理的随机对照试验(RCT)。应用RevMan5.4软件对资料进行meta分析。结果共纳入13篇文献,包括1322例脑卒中吞咽障碍患者和3种营养管理模式(多学科协作管理、集束化管理、个体化管理)。Meta分析结果显示,3种营养管理模式均能提高脑卒中吞咽障碍患者血清白蛋白水平,差异有统计学意义[均数差(MD)=4.46,95%可信区间(95%CI)2.55~6.38,P<0.00001];3种营养管理模式均能改善患者吞咽功能,差异有统计学意义[相对危险度(RR)=1.21,95%CI 1.11~1.32,P<0.0001]。多学科协作管理模式与个体化管理模式均能提高患者前血清蛋白水平,差异有统计学意义(MD=14.99,95%CI 9.90~20.07,P<0.00001)。个体化管理模式能提高患者血红蛋白水平,差异有统计学意义(MD=5.56,95%CI 2.83~8.30,P<0.0001)。集束化管理模式能提高患者肱三头肌皮褶厚度、上臂肌围、甘油三酯、总胆固醇值,差异均有统计学意义(MD=2.47,95%CI 1.54~3.39,P<0.00001;MD=6.74,95%CI 5.89~7.60,P<0.00001;MD=0.62,95%CI 0.51~0.74,P<0.00001;MD=1.05,95%CI 0.22~1.87,P=0.01)。多学科协作管理模式及个体化管理模式均能降低患者不良反应发生率,差异有统计学意义(RR=0.36,95%CI 0.18~0.72,P=0.004;RR=0.32,95%CI 0.20~0.52,P<0.00001)。结论3种营养管理模式均可改善患者营养状况和吞咽功能,临床工作中可根据患者的个体情况选择合适的营养管理模式。

Objective To explore the application effect of different nutritional management models in stroke patients with dysphagia.Methods PubMed,Web of Science,Embase,the Cochrane Library,CNKI,China Biomedical Literature Database,VIP and Wanfang Database were searched by computer to collect randomized controlled trials(RCT)on nutritional management of stroke patients with dysphagia published from the establishment of the database to July 2023.RevMan5.4 software was used to meta-analyse the data.Results A total of 13 articles were included,including 1322 stroke patients with dysphagia and three nutrition management models(multidisciplinary collaborative management,cluster management,and individualized management).The results of meta-analysis showed that all three nutritional management models could improve the serum albumin level of stroke patients with dysphagia,and the difference was statistically significant[mean difference(MD)=4.46,95%confidence interval(95%CI)2.55-6.38,P<0.00001].All the three nutrition management models could improve the swallowing function of patients,and the difference was statistically significant[relative risk(RR)=1.21,95%CI 1.11-1.32,P<0.0001].Both the multidisciplinary collaborative management model and the individualized management model could improve the pre-serum protein level of patients,and the difference was statistically significant(MD=14.99,95%CI 9.90-20.07,P<0.00001).The individualized management model could improve the hemoglobin level of patients,and the difference was statistically significant(MD=5.56,95%CI 2.83-8.30,P<0.0001).The bundle management model could improve the triceps skinfold thickness,upper arm muscle circumference,triglyceride and total cholesterol,and the differences were statistically significant(MD=2.47,95%CI 1.54-3.39,P<0.00001);MD=6.74,95%CI 5.89-7.60,P<0.00001;MD=0.62,95%CI 0.51-0.74,P<0.00001;MD=1.05,95%CI 0.22-1.87,P=0.01).Both multidisciplinary collaborative management mode and individualized management mode could reduce the incidence of adverse reactions in patients,and the difference was statistically significant(RR=0.36,95%CI 0.18-0.72,P=0.004;RR=0.32,95%CI 0.20-0.52,P<0.00001).Conclusion The three nutritional management models can improve the nutritional status and swallowing function of patients,and the appropriate nutritional management model can be selected based on the individual patient′s situation in clinical work.