Interventions to prevent aspiration pneumonia in older adults: A systematic review
Interventions to prevent aspiration pneumonia in older adults: A systematic review
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DOI：
10.1046/j.1365-2389.2003.51318.x
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发表时间：
2003-07-01
影响因子：
6.3
通讯作者：
Walker-Dilks, C
中科院分区：
文献类型：
--
作者：
Loeb, MB;Becker, M;Walker-Dilks, C
对以下预防老年人吸入性肺炎(AP)的干预措施进行了系统评价：代偿策略/体位改变、饮食干预、药物治疗、口腔卫生和管饲。数据来源包括MEDLINE、EMBASE、Cochrane图书馆、CINAHL和HealthSTAR数据库的关键词搜索和6种期刊的手工搜索。检索相关的主要文献和综述文献的参考文献目录。研究包括随机对照试验(RCT)，纳入65岁及以上有AP风险和评估的成年人。两名研究人员提取了有关人口、干预、结果和方法质量的数据。在17个确定的随机对照试验中，8个符合选择标准，2个涉及饮食管理或代偿性吞咽，2个评估药物治疗，1个评估口腔卫生，3个评估管饲。在八项试验中，没有一项报告使用了盲法，其中五项试验的分配隐藏情况不清楚。在疗养院居民的一项试验中，金刚烷胺的使用预防了肺炎。抗血栓药西洛他唑在另一项试验中阻止了AP，但导致大量出血。没有足够的数据来确定定位策略、改进的饮食、口腔卫生、喂养管放置或食物输送在预防AP方面的有效性。考虑到AP问题在老年人中是多么普遍，有必要对预防性干预措施的有效性进行更大规模、高质量的随机对照试验。
A systematic review was conducted to assess the effectiveness of the following interventions for prevention of aspiration pneumonia (AP) in older adults: compensatory strategy/positioning changes, dietary interventions, pharmacologic therapies, oral hygiene, and tube feeding. Data sources included a key word search of the MEDLINE, EMBASE, Cochrane Library, CINAHL, and HealthSTAR databases and hand searches of six journals. Reference lists of relevant primary and review articles were searched. Studies included were randomized, controlled trials (RCTs) enrolling adults aged 65 and older at risk of and assessed for AP. Two investigators extracted data on population, intervention, outcomes, and methodological quality. Of the 17 identified RCTs, eight met the selection criteria, two addressed dietary management or compensatory swallowing, two assessed pharmacological therapies, one assessed oral hygiene, and three assessed tube feeding. None of the eight trials reported use of blinding, and allocation concealment was unclear in five. Use of amantadine prevented pneumonia in one trial of nursing home residents. The antithrombotic agent cilostazol prevented AP in another trial but resulted in excessive bleeding. Insufficient data exist to determine the effectiveness of positioning strategies, modified diets, oral hygiene, feeding tube placement, or delivery of food in preventing AP. Considering how common the problem of AP is in older adults, larger, high-quality RCTs on the effectiveness of preventive interventions are warranted.