卒中后谵妄危险因素的Meta分析

doi:10.16460/j.issn1008-9969.2018.22.038

摘要/Abstract

摘要： 目的通过系统评价和Meta分析,明确卒中后谵妄（post stroke delirium, PSD）的危险因素,为有效预防脑卒中患者卒中后谵妄提供科学依据。方法在PubMed、EMbase、CINAHL、 Cochrane Library、PsycINFO、中国知网、万方数据库、中国生物医学文献数据库（CBM）、维普中文生物医学期刊数据库（VIP）中进行文献检索,收集2018年2月之前公开发表的关于卒中后谵妄危险因素的研究,并进行文献质量评价,应用Stata 14.0进行Meta分析,采用固定效应或随机效应模型进行数据合并,计算OR值和95%可信区间,用Begg秩相关和漏斗图判定发表偏倚。结果共纳入14篇文献,包括4 807例卒中患者,其中发生卒中后谵妄的患者784例（16.31%）,文献质量评价,均为中等或高质量研究。危险因素合并的OR值分别为：视觉障碍31.76（95%CI：11.61~86.86）、C反应蛋白升高7.64（95%CI：1.83~31.90）、认知障碍 7.48（95%CI：3.63~15.42）、前循环梗死5.24（95%CI：2.89~9.49）、出血性卒中3.70（95%CI：3.64~3.77）、感染3.67（95%CI：2.19~6.16）、卒中严重程度1.23（95%CI：1.06~1.42）、年龄1.07（95%CI：1.02~1.13）。Begg秩相关分析显示,前循环梗死存在一定的发表偏倚。结论视觉障碍、C反应蛋白升高、认知障碍、出血性卒中、感染、卒中严重程度、年龄等是卒中后谵妄的独立预测因子,而前循环梗死是卒中后谵妄危险因素的证据尚不充分。应针对脑卒中人群中存在的可改变的危险因素进行早期干预。

关键词: 脑卒中, 谵妄, 危险因素, 系统评价, Meta分析

Abstract: Objective To conduct a systematic review and meta-analysis of risk factors for post stroke delirium (PSD)and provide reference for effective prevention of PSD. Methods Studies on risk factors for PSD from PubMed, EMbase, CINAHL, Cochrane Library, PsycINFO, CNKI, Wanfang, CBM, VIP before February 2018 were searched. Two reviewers independently assessed the quality of included studies. Data were combined by fixed or random effects models using Stata 14.0. Begg test combined with funnel plot was implemented to evaluate publication bias. Results Fourteen studies were concluded with 4,807 stroke patients, among which 784(16.31%) were diagnosed with delirium. The quality of studies was moderate or high. A total of 8 risk factors were involved. The OR for these factors was vision deficits 31.76 (95%CI:11.61~86.86), increased C-reactive protein 7.64 (95%CI:1.83~31.90), cognitive decline 7.48 (95%CI：3.63~15.42), anterior circulation infarction 5.24 (95%CI:2.89~9.49), hemorrhagic stroke3.70(95%CI:3.64~3.77), infection 3.67 (95%CI:2.19~6.16), stroke severity 1.23 (95%CI:1.06~1.42), and age 1.07 (95%CI:1.02~1.13) resepetively. Publish bias existed in anterior circulation infarction. Conclusion Vision deficits, increased C-reactive protein, cognitive decline, hemorrhagic stroke, infection, stroke severity and age are risk factors for PSD. Evidences are not sufficient for the impact of anterior circulation infarction on PSD. Early intervention for these modifiable risk factors is recommended.

Key words: stroke, delirium, risk factor, systematic review, Meta-analysis

中图分类号:

R248.2

李真, 曹晶, 李佳倩, 吴欣娟. 卒中后谵妄危险因素的Meta分析[J]. 护理学报, 2018, 25(22): 38-43.

LI Zhen, CAO Jing, LI Jia-qian, WU Xin-juan. Systematic Review and Meta-analysis of Risk Factors of Post Stroke Delirium[J]. Journal of Nursing, 2018, 25(22): 38-43.

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