老年精神障碍患者肺部感染发生率及影响因素的Meta分析
Incidence and risk factors of pulmonary infections in elderly patients with mental disorders: A meta-analysis
投稿时间:2024-08-06  修订日期:2024-11-20
DOI:
中文关键词:  【】老年  精神障碍  肺部感染  危险因素  Meta分析
英文关键词:Aged  Mental Disorders  Pulmonary Infection  Risk Factors  Meta-Analysis
基金项目:树鼩新型精神分裂症模型的建立及机制研究(82160269) 国家自然科学基金(地区科学基金项目)
作者单位地址
吴雨潇 云南省精神病医院 云南省昆明市穿金路733号
行浩然 云南省精神病医院 
鲍天昊* 云南省精神病医院 云南 昆明 云南省昆明市穿金路733号
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中文摘要:
      【】背景 随着人口老龄化的加剧,老年精神障碍患者数量显著增加。肺部感染在这一人群中的高发生率是导致医疗负担加重和死亡率上升的主要因素之一,因此成为临床预防和管理的重要挑战。目的 本研究旨在探讨老年精神障碍患者肺部感染的发生率及其影响因素,为其预防和管理提供科学依据。方法 通过计算机检索中国知网、中国生物医学数据库、万方数据库、PubMed、Web of Science、Embase、Cochrane Library、Ovid等数据库,包括截至2024年6月的相关文献。使用Stata 16.0软件进行Meta分析,两名研究者独立进行文献筛选、数据提取和质量评估。结果 共纳入16篇文献(中文13篇,英文3篇),涵盖75474名患者。Meta分析显示,老年精神障碍患者的肺部感染发生率为21.0% [95%CI: 15.3%-26.7%]。亚组分析显示,痴呆、精神分裂症、未分类的精神障碍患者的肺部感染发生率分别为21.9% [95%CI: 18.2%-25.6%]、20.6% [95%CI: 12.9%-28.3%]和5.2% [95%CI: 4.3%-6.2%]。影响因素的Meta分析结果显示,精神疾病量表评分的OR值无统计学意义(P≥0.05),但合并糖尿病(OR=2.05,95%CI=1.52-2.76)、长期卧床(OR=2.41,95%CI=1.91-3.04)、吞咽障碍(OR=1.76,95%CI=1.53-2.03)、吸烟史(OR=1.85,95%CI=1.35-2.55)、抗菌药使用(OR=1.98,95%CI=1.67-2.35)、低白蛋白血症(OR=1.57,95%CI=1.35-1.83)、病程(OR=2.07,95%CI=1.80-2.39)、年龄(OR=5.01,95%CI=1.91-13.13)、住院时间(OR=2.68,95%CI=1.65-4.34)、质子泵抑制剂使用(OR=1.10,95%CI=1.06-1.14)、慢性肺部疾病史(OR=1.50,95%CI=1.43-1.57)、口腔卫生不良(OR=3.66,95%CI=1.01-13.23)、合并肿瘤(OR=3.12,95%CI=2.18-4.48)、合并超过两种并发症(OR=4.01,95%CI=1.08-14.86)均显示出统计学意义(P<0.05)。研究结果表明,这些因素是影响老年精神障碍患者肺部感染发生的重要危险因素。结论 老年精神障碍患者肺部感染率较高,不同类型的精神障碍患者之间存在差异,老年期痴呆患者的感染率最高。年龄、病程、吸烟史、合并躯体疾病、低蛋白血症、长期卧床、吞咽障碍、口腔卫生状况、抗菌药物使用、质子泵抑制剂使用以及住院时间是主要的影响因素。应当对这类患者进行全面评估,早期发现、预防和干预,减少肺部感染的发生率。
英文摘要:
      【】Background With the exacerbation of population aging, there has been a significant increase in elderly patients with psychiatric disorders. The high incidence of pulmonary infections in this population is a major factor contributing to increased healthcare burden and mortality rates, posing a significant challenge for clinical prevention and management. Objective This study aimed to explore the incidence of pulmonary infections among elderly patients with psychiatric disorders and identify contributing factors to provide scientific evidence for prevention and management. Methods Relevant literature up to June 2024 was retrieved from databases including CNKI, CBM, Wanfang, PubMed, Web of Science, Embase, Cochrane Library, and Ovid. Meta-analysis was conducted using Stata 16.0 software, with two researchers independently screening literature, extracting data, and assessing quality. Results A total of 16 studies (13 in Chinese, 3 in English) involving 75,474 patients were included. Meta-analysis revealed a pulmonary infection rate of 21.0% [95%CI: 15.3%-26.7%] among elderly psychiatric patients. Subgroup analysis indicated infection rates of 21.9% [95%CI: 18.2%-25.6%], 20.6% [95%CI: 12.9%-28.3%], and 5.2% [95%CI: 4.3%-6.2%] for dementia, schizophrenia, and unspecified psychiatric disorders, respectively. Meta-analysis of influencing factors showed that while the OR of psychiatric rating scale scores was not statistically significant (P≥0.05), comorbid diabetes (OR=2.05, 95%CI=1.52-2.76), prolonged bed rest (OR=2.41, 95%CI=1.91-3.04), dysphagia (OR=1.76, 95%CI=1.53-2.03), smoking history (OR=1.85, 95%CI=1.35-2.55), antimicrobial use (OR=1.98, 95%CI=1.67-2.35), hypoalbuminemia (OR=1.57, 95%CI=1.35-1.83), disease duration (OR=2.07, 95%CI=1.80-2.39), age (OR=5.01, 95%CI=1.91-13.13), length of hospital stay (OR=2.68, 95%CI=1.65-4.34), proton pump inhibitor use (OR=1.10, 95%CI=1.06-1.14), chronic pulmonary disease history (OR=1.50, 95%CI=1.43-1.57), poor oral hygiene (OR=3.66, 95%CI=1.01-13.23), comorbid tumors (OR=3.12, 95%CI=2.18-4.48), and multiple complications (OR=4.01, 95%CI=1.08-14.86) were statistically significant (P<0.05). These results underscore these factors as critical contributors to pulmonary infections in elderly psychiatric patients. Conclusion The incidence of pulmonary infections is notably high among elderly psychiatric patients, with variations observed among different psychiatric disorder types, notably higher in dementia. Age, disease duration, smoking history, comorbid physical illnesses, hypoalbuminemia, prolonged bed rest, dysphagia, oral hygiene status, antimicrobial use, proton pump inhibitor use, and length of hospital stay are major influencing factors. Comprehensive assessment and early detection, prevention, and intervention strategies are crucial to mitigate the occurrence of pulmonary infections in this vulnerable population.
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