老年骨折患者围手术期营养不良危险因素的Meta分析  

Meta-analysis of risk factors for perioperative malnutrition among aged fracture patients

作　　者：何志强 吴文斌 林子涵 李津 王婧 周晓玲[3] 张慧芳 He Zhiqiang;Wu Wenbin;Lin Zihan;Li Jin;Wang Jing;Zhou Xiaoling;Zhang Huifang(Department of Nursing,Xi'an Jiaotong University Health Science Center,Xi'an 710061,China;Department of Nursing,Affiliated Cancer Hospital of Zhengzhou University(Henan Cancer Hospital),Zhengzhou 450008,China;Department of Orthopedics,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Breast Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学医学部护理学系,西安710061 [2]郑州大学附属肿瘤医院(河南省肿瘤医院)护理部,郑州450008 [3]西安交通大学第一附属医院骨科,西安710061 [4]西安交通大学第一附属医院乳腺外科,西安710061

出　　处：《中华现代护理杂志》2024年第20期2743-2750,共8页Chinese Journal of Modern Nursing

摘　　要：目的:系统评价老年骨折患者围手术期发生营养不良的危险因素。方法:通过计算机检索中国知网、万方数据库、维普网、中国生物医学文献数据库、Web of Science、Embase、PubMed、CINAHL,搜集建库至2023年5月10日关于老年骨折患者围手术期营养不良危险因素的文献,并通过滚雪球法与手工检索灰色文献进行补充。由2名经过循证护理培训的硕士研究生独立筛选文献、数据提取以及方法学质量评价,采用RevMan 5.4软件进行Meta分析。结果:最终纳入14篇原始研究,涵盖46项营养不良危险因素。对2篇及以上文献所涉及因素进行Meta分析结果显示:年龄≥70岁、低体重指数、低血红蛋白、术前低白蛋白、女性、身体活动少、居住地不在家、自理能力低、骨折类型为股骨粗隆间骨折、慢性阻塞性肺部疾病、慢性胃炎、痴呆/认知下降、癌症、脑卒中、慢性心衰、合并慢性病、查尔斯共病指数高、体重减轻、抑郁、美国麻醉医师协会麻醉分级≥Ⅲ级、服药种类≥4种、住院时间长均会增加老年骨折患者围手术期营养不良发生率( P<0.05)。 结论:老年骨折群体围手术期营养不良发生率较高,且影响因素繁多;提示医护人员应针对高风险患者开展动态、精确的营养筛查,做好围手术期个性化营养管理,预防营养不良的发生,促进老年骨折患者快速康复。ObjectiveTo systematically evaluate the risk factors for perioperative malnutrition in aged fracture patients.MethodsA comprehensive search of databases including CNKI,WanFang,VIP,SinoMed,Web of Science,Embase,PubMed,and CINAHL was conducted to identify relevant studies on risk factors for perioperative malnutrition in aged fracture patients from inception to May 10,2023.Additional grey literature was identified by snowball sampling and manual searches.Two postgraduate students trained in evidence-based nursing independently screened the literature,extracted data,and assessed the methodological quality of the studies.Meta-analysis was performed using RevMan 5.4 software.ResultsFourteen original studies were included,covering 46 risk factors for malnutrition.Meta-analysis of factors reported in at least two studies indicated that age≥70 years,low body mass index,low hemoglobin,preoperative hypoalbuminemia,female,physical inactivity,non-home residence,low self-care ability,intertrochanteric fracture,chronic obstructive pulmonary disease,chronic gastritis,dementia/cognitive decline,cancer,stroke,chronic heart failure,multiple chronic diseases,high Charlson Comorbidity Index,weight loss,depression,American Society of Anesthesiologists classification≥Ⅲ,taking multiple medications≥4 types,and longer hospital stays all increased the incidence of perioperative malnutrition in aged fracture patients(P<0.05).ConclusionsThe incidence of perioperative malnutrition in the aged fracture population is high and influenced by multiple factors.This highlights the need for healthcare providers to conduct dynamic and precise nutritional screenings for high-risk patients and to implement personalized perioperative nutritional management to prevent malnutrition and promote rapid recovery in aged fracture patients.

关 键 词：老年人 骨折 围手术期 营养不良 META分析 危险因素 

分 类 号：R473.6[医药卫生—护理学]