Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review.
Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review.
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DOI：
10.1007/s00455-019-10061-6
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发表时间：
2020-10
期刊：
影响因子：
2.6
通讯作者：
Pownall S
中科院分区：
文献类型：
--
作者：
Eltringham SA;Kilner K;Gee M;Sage K;Bray BD;Smith CJ;Pownall S
吞咽困难与卒中相关性肺炎（SAP）风险增加相关。然而，目前还不清楚其他因素导致的风险或哪些措施可以降低it. This系统的审查，旨在提供证据的干预措施和护理过程与SAP吞咽困难患者。如果研究仅包括吞咽困难患者、吞咽困难和非吞咽困难患者或包括吞咽困难患者并评价与记录的SAP频率相关的因素的非吞咽困难患者，则对研究进行入选筛选。检索了从开始到2017年2月的电子数据库。对合格的研究进行了严格评价。使用I2评价杂合性。主要结局为SAP。纳入了11项研究。样本量范围为60至1088例患者。研究设计存在异质性。吞咽困难患者的免疫抑制措施与SAP相关。没有足够的证据证明筛查需氧革兰氏阴性菌是合理的。预防性抗生素不能预防SAP，质子泵抑制剂可能增加风险。甲氧氯普胺治疗可降低SAP风险。鼻胃管（NGT）放置增加SAP风险的证据尚不明确。多学科团队的方法和吞咽的仪器评估可能会降低肺炎的风险。活动能力受损的患者与风险增加相关。鉴于研究数量、异质性和描述性分析，应谨慎解释结果。已经确定了几种可能降低吞咽困难患者SAP风险的医疗干预和护理过程。需要进一步的研究来评估这些干预措施和护理过程在临床实践中的作用。本文的在线版本（10.1007/s 00455 -019-10061-6）包含补充材料，可供授权用户使用。
Dysphagia is associated with increased risk of stroke-associated pneumonia (SAP). However, it is unclear what other factors contribute to that risk or which measures may reduce it. This systematic review aimed to provide evidence on interventions and care processes associated with SAP in patients with dysphagia. Studies were screened for inclusion if they included dysphagia only patients, dysphagia and non-dysphagia patients or unselected patients that included dysphagic patients and evaluated factors associated with a recorded frequency of SAP. Electronic databases were searched from inception to February 2017. Eligible studies were critically appraised. Heterogeneity was evaluated using I2. The primary outcome was SAP. Eleven studies were included. Sample sizes ranged from 60 to 1088 patients. There was heterogeneity in study design. Measures of immunodepression are associated with SAP in dysphagic patients. There is insufficient evidence to justify screening for aerobic Gram-negative bacteria. Prophylactic antibiotics did not prevent SAP and proton pump inhibitors may increase risk. Treatment with metoclopramide may reduce SAP risk. Evidence that nasogastric tube (NGT) placement increases risk of SAP is equivocal. A multidisciplinary team approach and instrumental assessment of swallowing may reduce risk of pneumonia. Patients with impaired mobility were associated with increased risk. Findings should be interpreted with caution given the number of studies, heterogeneity and descriptive analyses. Several medical interventions and care processes, which may reduce risk of SAP in patients with dysphagia, have been identified. Further research is needed to evaluate the role of these interventions and care processes in clinical practice. The online version of this article (10.1007/s00455-019-10061-6) contains supplementary material, which is available to authorized users.
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