老年综合评估在髋关节骨折老年患者中应用的系统评价

摘要

目的 系统评价老年综合评估(CGA)应用于髋关节骨折老年患者对于减少谵妄发生率、缩短住院时间、减少病死率的有效性.方法 2017年6月—2018年2月,计算机检索MEDLINE、EMBASE、PUBMED、CENTRAL、PsycINFO、中国生物医学文献数据库(CBM)、CNKI、中国科技期刊全文数据库(VIP)、万方数据库,检索时间为建库至2018年1月.收集所有CGA应用于髋关节骨折老年患者的随机对照试验(RCT)和临床对照研究.2名研究者按照纳入和排除标准独立检索文献、筛选文献、评价纳入文献的质量,并提取资料,使用ReManv 5.3软件进行Meta分析.结果 共纳入14篇文献,均为RCT.Meta分析结果显示,CGA组与对照组谵妄发生率对比差异有统计学意义[Z=3.33,P=0.001,OR=0.82,95％CI(0.74～0.92)];患者半年内病死率对比差异有统计学意义[Z=2.89,P=0.004,OR=0.66,95％CI(0.49～0.87)];住院时间对比无统计学意义(Z=1.32,P=0.19);功能丧失率对比差异有统计学意义[Z=2.92,P=0.003,OR=0.78,95％CI(0.66～0.92)].结论 CGA能减少老年髋部骨折术后谵妄的发生率,灵活团队随访为基础的CGA比老年病房为基础的CGA效果更佳,CGA可以降低半年内病死率,减少患者关节活动丧失率.%Objective To comprehensively review the effect of comprehensive geriatric assessment (CGA)on reducing the incidence of delirium,shortening the length of stay and reducing the morbidity among elderly patients with hip fractures. Methods From June 2017 to February 2018,we retrieved the MEDLINE,EMBASE,PubMed,CENTRAL,PsycINFO,China Biology Medicine,China National Knowledge Infrastructure(CNKI),Vip Database(VIP)and WanFang data published from establishing database to January 2018. We collected the randomized controlled trials and clinical trials on the application of comprehensive geriatric assessment in elderly patients with hip fractures. Two researchers independently explored literature, screen literature and assess the quality of the included literature according to the inclusion and exclusion criteria,and extract the data. ReManv 5.3 was used to Meta-analysis. Results A total of 14 literature were enrolled and RCT. Meta-analysis showed that there was statistical differences in the incidence of delirium [Z=3.33,P=0.001,OR=0.82,95％CI(0.74-0.92)]and the morbidity within half a year[Z=2.89,P=0.004, OR=0.66,95％CI(0.49-0.87)],function losing rate[Z=2.92,P=0.003,OR=0.82,95％CI(0.66-0.92)]but no statistical difference in the length of stay(Z=1.32,P=0.19)between the CGA group and control group. Conclusions CGA can reduce the incidence of delirium among elderly patients with hip fractures after surgery. Compared with the CGA based on elderly ward,CGA based on agile team follow-up has good effects which can reduce the morbidity within half a year and function losing rate of patients.