机械通气患者拔管后吞咽障碍发生率及影响因素的Meta分析  

Incidence and influencing factors of post-extubation dysphagia among patients with mechanical ventilation: a meta-analysis

作　　者：胡英莉 蔡梦歆 史冬雷[3] Hu Yingli;Cai Mengxin;Shi Donglei(Central Treatment Room, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China;Emergency Department, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China;Nursing Department, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医院中心治疗室,100730 [2]中国医学科学院北京协和医院急诊科,100730 [3]中国医学科学院北京协和医院护理部,100730

出　　处：《中华现代护理杂志》2019年第17期2158-2163,共6页Chinese Journal of Modern Nursing

摘　　要：目的系统分析机械通气患者拔管后吞咽障碍(PED)的发生率及影响因素。方法系统检索PubMed、CIHNAL、Cochrane Library、万方数据、CNKI、维普等数据库中关于PED的观察性研究。对所得文献进行筛选、提取资料、评价文献质量,采用Stata 14.0软件进行Meta分析。结果共检索文献1 356篇,筛选后纳入8项研究,其中队列研究5篇,横断面调查3篇;共包含2 384例研究对象,其中PED 553例。Meta分析结果显示,PED的总发生率为36%(95%CI:23%~50%),插管时间≥48 h患者PED的发生率为46%(95%CI:40%~53%);<48 h者PED的发生率为6%(95%CI:5%~7%)。插管时间和年龄是PED的独立影响因素。亚组分析结果显示插管时间<48 h者,年龄为影响因素(OR=2.18,95%CI:1.42~3.34),但插管时间是否为影响因素尚无法确定。插管时间≥48 h者,年龄(OR=1.02,95%CI:1.00~1.05)和插管时间(OR=1.28,95%CI:1.08~1.52)均为影响因素。发表偏倚分析纳入文献不存在明显偏倚,结果较为可靠。结论重视机械通气患者PED的问题,着重加强对插管时间≥48 h及年龄较大患者的关注,促进PED的早期发现和早期干预。Objective To systematically analyze the incidence and influencing factors of post-extubation dysphagia (PED) among patients with mechanical ventilation. Methods Observational studies on PED were systematically retrieved in PubMed, CIHNAL, Cochrane Library, WanFang data, China National Knowledge Infrastructure (CNKI) and VIP. We screened literatures, extracted data and evaluated the literature quality. The Stata14.0 was used to meta-analysis. Results A total of 1 356 literatures were retrieved and 8 of them were included, 5 literatures on cohort study and 3 on cross-sectional study. Totals of 2 384 research objects were included and 553 of them were with PED. Meta-analysis showed that the incidence of PED was 36%(95% CI: 23%-50%), the rates of PED patients with intubation time ≥48 h and <48 h were 46%(95%CI: 40%-53%) and 6%(95%CI: 5%-7%) respectively. The independent influencing factors of PED were the intubation time and ages. Subgroup analysis revealed that the ages (OR=2.18, 95%CI: 1.42~3.34) was the influencing factor among patients with intubation time <48 h, but intubation time could not be determined;the ages (OR=1.02, 95%CI: 1.00-1.05) and intubation time (OR=1.28, 95%CI: 1.08-1.52) were the influencing factors among patients with intubation time ≥48 h. Publication bias analysis showed that the included literatures were with no significant bias and with credible results. Conclusions We should pay attention to problems existing in PED among patients with mechanical ventilation particularly in patients with intubation time ≥48 h and old ages, so as to promote early detection and early intervention of PED.

关 键 词：META分析 呼吸 人工 拔管后吞咽障碍 

分 类 号：R473[医药卫生—护理学]