以质量求发展，以服务铸品牌
2025年5月11日 星期日

护理学报 ›› 2025, Vol. 32 ›› Issue (1): 44-49.doi: 10.16460/j.issn1008-9969.2025.01.044

• 循证护理 • 上一篇    下一篇

减重代谢术后骨质疏松症预防与管理的最佳证据总结

毕雅昕1a, 端烨1b, 何丽君1a, 徐秒2, 龚荣花1a   

  1. 1.江苏省苏北人民医院 a.手术室; b.胃肠科,江苏 扬州 225000;
    2.昆山市第一人民医院 手术室,江苏 昆山 215300
  • 收稿日期:2024-04-28 出版日期:2025-01-10 发布日期:2025-02-20
  • 通讯作者: 龚荣花（1977-）,女,江苏扬州人,本科学历,主任护师,科护士长。E-mail：862124229@qq.com
  • 作者简介:毕雅昕（1996-）,女,江苏扬州人,硕士,护师。
  • 基金资助:
    江苏省苏北医院院级课题（SBHL22002）

Best evidence summary for prevention and management of osteoporosis after metabolic, bariatric surgery

BI Ya-xin1a, DUAN Ye1b, HE Li-jun1a, XU Miao2, GONG Rong-hua1a   

  1. 1a. Operating Room; 1b. Dept. of Gastroenterology, Northern Jiangsu People' s Hospital, Yangzhou, 225000, China;
    2. Operating Room, the First People' s Hospital of Kunshan, Kunshan, 215300, China
  • Received:2024-04-28 Online:2025-01-10 Published:2025-02-20

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摘要： 目的 检索、评价并总结减重代谢患者术后骨质疏松症预防和管理的最佳证据。 方法 系统检索国内外相关指南网站、循证数据库、相关协会网站及学术文献数据库等有关减重代谢术后骨质疏松症预防与管理的相关证据。检索时限为建库至2024年3月。由4名接受过系统循证培训的研究者筛选文章、提取资料、并采取相应的质量评价工具进行文献质量分级,总结该人群术后骨质疏松症预防和管理的最佳证据。 结果 共纳入12篇文献,包括4篇指南、3篇专家共识、1篇临床决策及4篇系统评价,纳入的文献总体质量较高。从预防措施、营养补充、运动管理、药物治疗、定期随访和健康教育6个方面总结了20条最佳证据。 结论 减重代谢术后骨质疏松症应引起重视,医护人员应结合临床实际和患者的需求,合理选择使用证据。同时关注该人群术后全方位、多方式的管理,制定减重代谢术后骨质疏松症人群的个性化治疗方案。

关键词: 减重代谢手术, 骨质疏松症, 循证医学, 证据总结, 最佳证据

Abstract: Objective To retrieve, evaluate, and summarize the best evidence for the prevention and management for postoperative osteoporosis in patients after metabolic and bariatric surgery. Methods A systematic search was conducted to retrieve domestic and international guideline websites, evidence-based databases, websites of relevant associations, and databases of scholarly literature on the prevention and management of osteoporosis after metabolic and bariatric surgery. The retrieval time spanned from the inception to March 2024. Four researchers with evidence-based training screened literature, extracted information, and graded the quality of the literature using appropriate assessment tools to summarize the best evidence for the prevention and management of postoperative osteoporosis in this population. Results A total of 12 studies were included, including 4 guidelines, 3 expert consensus, 1 clinical decision and 4 systematic reviews, and the overall quality of the included studies was high. Totally, twenty pieces of best evidence were summarized into six aspects of preventive measures, nutritional supplementation, exercise management, pharmacological treatment, regular follow-up and health education. Conclusion Great importance should be attached to postoperative osteoporosis after metabolic and bariatric surgery, and healthcare professionals should use the evidence rationally, taking clinical practice and patients' needs into account. Meanwhile, all-round, multimodal management of this population after surgery should be considered and individualized treatment plans for people with osteoporosis after metabolic and bariatric surgery should be developed.

Key words: metabolic and bariatric surgery, osteoporosis, evidence-based medicine, evidence summary, best evidence

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  • R473.6
[1] Finkelstein EA, Khavjou OA, Thompson H, et al.Obesity and severe obesity forecasts through 2030[J].Am J Prev Med,2012,42(6):563-570.DOI:10.1016/j.amepre.2011.10.026.
[2] Ryan DH, Kahan S.Guideline recommendations for obesity management[J]. Med Clin North Am, 2018,102(1):49-63.DOI:10.1016/j.mcna.2017.08.006.
[3] Angrisani L, Santonicola A, Iovino P, et al.Bariatric surgery worldwide 2013[J]. Obes Surg,2015,25(10):1822-1832.DOI:10.1007/s11695-015-1657-z.
[4] O'Brien PE, Hindle A, Brennan L, et al. Long-term outcomes after bariatric surgery: a systematic review and Meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding[J]. Obes Surg,2019,29(1):3-14.DOI:10.1007/S11695-018-3525-0.
[5] Wiggins T, Guidozzi N, Welbourn R, et al.Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: a systematic review and Meta-analysis[J].PLoS Med,2020,17(7):e1003206.DOI:10.1371/journal.pmed.1003206.
[6] Beavers KM, Greene KA, Yu EW.Management of endocrine disease: bone complications of bariatric surgery: updates on sleeve gastrectomy, fractures, and interventions[J]. Eur J Endocrinol, 2020, 183(5):R119-132.DOI:10.1530/EJE-20-0548.
[7] 杨迪, 韩峻峰. 减重手术后身体成分影响骨代谢的研究进展[J]. 同济大学学报(医学版),2022,43(4):586-590.DOI:10.12289/j.issn.1008-0392.21372.
[8] 朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.DOI:10.16821/j.cnki.hsjx.2017.21.025.
[9] Alper BS, Haynes RB.EBHC pyramid 5.0 for accessing preappraised evidence and guidance[J]. Evid Based Med,2016,21(4):123-125.DOI:10.1136/ebmed-2016-110447.
[10] 韦当, 王聪尧, 肖晓娟, 等. 指南研究与评价(AGREEⅡ)工具实例解读[J]. 中国循证儿科杂志,2013,8(4):316-319.DOI:10.3969/j.issn.1673-5501.2013.04.017.
[11] 顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具——系统评价的方法学质量评价[J]. 护士进修杂志,2018,33(8):701-703.DOI:10.16821/j.cnki.hsjx.2018.08.008.
[12] 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志,2015, 30(11):964-967.
[13] Scottish Intercollegiate Guidelines Network (SIGN). Management of osteoporosis and the prevention of fragility fractures. Edinburgh: SIGN; 2021.[2021-01-01]. . Management of osteoporosis and the prevention of fragility fractures. Edinburgh: SIGN; 2021.[2021-01-01]. http://www.sign.ac.uk.
[14] Mechanick JI, Apovian C, Brethauer S, et al.Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association Of Clinical Endocrinologists/American College Of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, And American Society Of Anesthesiologists-Executive Summary[J]. Endocr Pract,2019,25(12):1346-1359.DOI:10.4158/GL-2019-0406.
[15] Qaseem A, Forciea MA, McLean RM, et al. Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians[J]. Ann Intern Med,2017,167(12):899.DOI:10.7326/L17-0489.
[16] Gregson CL, Armstrong DJ, Bowden J, et al.UK clinical guideline for the prevention and treatment of osteoporosis[J]. Arch Osteoporos,2022,17(1):1-46.DOI:10.1007/s11657-022-01061-5.
[17] Kushner RF, Herron DM, Herrington H.Bariatric surgery: Postoperative nutritional management[EB/OL].[2024-04-01].https://www.uptodate.com/contents/zh-Hans/bariatric-surgery-postoperative-nutritional-management.
[18] Paccou J, Genser L, Lespessailles é, et al.French recommendations on the prevention and treatment of osteoporosis secondary to bariatric surgery[J]. Joint Bone Spine,2022,89(6):105443. DOI:10.1016/j.jbspin.2022.105443.
[19] Kim J,Nimeri A, Khorgami Z,et al.Metabolic bone changes after bariatric surgery: 2020 update, American Society for Metabolic and Bariatric Surgery Clinical Issues Committee position statement[J]. Surg Obes Relat Dis,2021,17(1):1-8.DOI:10.1016/j.soard.2020.09.031.
[20] 苏佳灿, 侯志勇, 刘国辉, 等. 中国骨质疏松性骨折围手术期处理专家共识(2018)[J]. 中国临床医学,2018,25(5):860-867.DOI:10.12025/j.issn.1008-6358.2018.20181053.
[21] Ablett AD, Boyle BR, Avenell A.Fractures in adults after weight loss from bariatric surgery and weight management programs for obesity: systematic review and Meta-analysis[J].Obes Surg, 2019,29(4):1327-1342.DOI:10.1007/s11695-018-03685-4.
[22] Salman MA, Aradaib M, Salman A, et al.Effects of gastric bypass and sleeve gastrectomy on bone mineral density and bone turnover markers: a systematic review and Meta-analysis[J]. World J Surg,2022,46(4):865-875.DOI:10.1007/s00268-021-06429-1.
[23] Diniz-Sousa F, Boppre G, Veras L, et al.The effect of exercise for the prevention of bone mass after bariatric surgery: a systematic review and Meta-analysis[J]. Obes Surg,2022,32(3):912-923.DOI:10.1007/s11695-021-05873-1.
[24] Marcil G, Bourget-Murray J, Shinde S, et al.The incidence of fractures following bariatric surgery: a systematic review[J].Int J Surg Open,2018,14:9-14.DOI:10.1016/j.ijso.2018.08.005.
[25] Sioen I, Michels N, Polfliet C, et al.The influence of dairy consumption, sedentary behaviour and physical activity on bone mass in Flemish children: a cross-sectional study[J]. BMC Public Health, 2015, 15(1):717.DOI:10.1186/s12889-015-2077-7.
[26] Dixon JB, Zimmet P, Alberti KG, et al.Bariatric surgery: an IDF statement for obese Type 2 diabetes[J]. Arq Bras Endocrinol Metabol,2011,55(6):367-382.DOI:10.1590/s0004-27302011000600003.
[27] Fischer LE, Moreno-Garcia F, Tran R, et al.Prevalence and risk factors for secondary hyperparathyroidism (SHPT) in patients undergoing bariatric surgery[J]. Surg Endosc,2023,37(10):8019-8028.DOI:10.1007/s00464-023-10218-3.
[28] 李路娇, 于健春, 李梅. 减重手术后骨质疏松症管理[J]. 中国实用内科杂志,2018, 38(2):162-165.DOI:10.19538/j.nk2018020114.
[29] Wu KC, Cao S, Weaver CM, et al.Intestinal calcium absorption decreases after laparoscopic sleeve gastrectomy despite optimization of vitamin D status[J]. J Clin Endocrinol Metab,2023, 108(2):351-360.DOI:10.1210/clinem/dgac579.
[30] Ormsbee MJ, Prado CM, Ilich JZ, et al.Osteosarcopenic obesity: the role of bone, muscle, and fat on health[J]. J Cachexia Sarcopenia Muscle, 2014, 5(3):183-192. DOI:10.1007/s13539-014-0146-x.
[31] Ilich JZ, Kelly OJ, Inglis JE, et al.Interrelationship among muscle, fat, and bone: connecting the dots on cellular, hormonal, and whole body levels[J]. Ageing Res Rev,2014(15):51-60.DOI:10.1016/j.arr.2014.02.007.
[32] 任子淇, 张天资, 杨宁琍, 等. 肥胖人群减重代谢术后运动康复方案的构建研究[J]. 中国全科医学,2019,22(19):2332-2339.DOI:10.12114/j.issn.1007-9572.2019.00.240.
[33] 宗小燕, 宗前兴, 王雪菲, 等. 骨质疏松老年人运动干预的最佳证据总结[J]. 护理学报,2023,30(12):56-61.DOI:10.16460/j.issn1008-9969.2023.12.056.
[34] 彭永徳. 骨质疏松症的药物治疗进展[J]. 中国临床保健杂志,2022,25(1):17-21.DOI:10.3969/J.issn.1672-6790.2022.01.004.
[35] 李莹莹, 李瑞玲, 李静, 等. 减重代谢手术病人术后维生素和微量元素补充依从性研究进展[J]. 护理研究,2023,37(2):280-283.DOI:10.12102/j.issn.1009-6493.2023.02.018.
[36] 雷雪姣, 倪翠萍, 李志文, 等. 肥胖症患者减重代谢术后心理体验质性研究的Meta整合[J]. 护理学报, 2022,29(19):41-46.DOI:10.16460/j.issn1008-9969.2022.19.041.
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