摘要
背景尿路感染为神经源性膀胱患者最常见的并发症,严重影响患者疗效与生活质量,尽早识别其相关因素,并针对性地预防与干预对改善患者预后有重要意义。近年来学者对尿路感染影响因素研究日益增多但结论仍存有争议,且目前缺少相关系统综述,无循证医学支撑。目的系统评价神经源性膀胱患者尿路感染的危险因素。方法计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方数据知识服务平台、维普网以及中国生物医学文献数据库中关于神经源性膀胱患者尿路感染危险因素的文献,检索时限为建库至2022年6月,采用纽卡斯尔-渥太华量表(NOS)评分对纳入文献进行质量评价,使用RevMan 5.3软件进行Meta分析。结果共纳入13篇文献,总病例数为3319例,文献的NOS评分为6~8分。Meta分析结果表明,高龄[OR_(≥60岁)=2.50,95%CI(1.83,3.41),P<0.00001;OR_(≥65岁)=2.13,95%CI(1.40,3.25),P=0.0004]、合并糖尿病[OR=3.17,95%CI(2.58,3.89),P<0.00001]、低蛋白血症[OR=2.26,95%CI(1.67,3.06),P<0.00001]、卒中次数≥2次[OR=3.30,95%CI(1.70,6.41),P=0.0004]、留置导尿管[OR=2.88,95%CI(2.09,3.95),P<0.00001]、间歇导尿频率≥2次/周[OR=2.44,95%CI(1.62,3.68),P<0.0001]、膀胱冲洗频率≥3次/周[OR=2.63,95%CI(1.66,4.17),P<0.0001]、膀胱功能训练介入时间≥2周[OR=2.75,95%CI(1.69,4.46),P<0.0001]、康复介入时间>7 d[OR=3.03,95%CI(1.42,6.48),P=0.004]是神经源性膀胱患者尿路感染的危险因素;男性[OR=0.78,95%CI(0.63,0.96),P=0.02]是神经源性膀胱患者发生尿路感染的保护因素。结论高龄、合并糖尿病、低蛋白血症、卒中次数≥2次、留置导尿管、间歇导尿频率≥2次/周、膀胱冲洗频率≥3次/周、膀胱功能训练介入时间≥2周、康复介入时间>7 d可能为神经源性膀胱患者尿路感染的危险因素,临床医务人员可及早识别高危因素,并对可干预因素予以针对性控制,以预防或减少患者尿路感染的发生。
Background Urinary tract infection is the most common complication in patients with neurogenic bladder,which severely affects the treatment effect and quality of life of patients.Early identification of its related factors and delivery of targeted measures of prevention and intervention are of great significance to improve the prognosis of patients.Recent studies on influencing factors of urinary tract infection in neurogenic bladder are increasing but have controversial results,and there is a lack of relevant systematic reviews and support from evidence-based medicine.Objective To systematically assess the risk factors of urinary tract infection in neurogenic bladder.Methods Databases of PubMed,Web of Science,Cochrane Library,Embase,CNKI,Wanfang Data,CQVIP,and SinoMed were searched for literature on risk factors of urinary tract infection in patients with neurogenic bladder from inception to June 2022.The quality of the included literature was assessed using the Newcastle-Ottawa Scale(NOS).RevMan 5.3 was used for meta-analysis.Results A total of 13 articles with 3319 cases were included.The NOS score of the articles ranged from 6 to 8.Meta-analysis results showed that advanced age〔OR_(≥60)=2.50,95%CI(1.83,3.41),P<0.00001;OR_(≥65)=2.13,95%CI(1.40,3.25),P=0.0004〕,diabetes〔OR=3.17,95%CI(2.58,3.89),P<0.00001〕,hypoalbuminemia〔OR=2.26,95%CI(1.67,3.06),P<0.00001〕,number of strokes≥2〔OR=3.30,95%CI(1.70,6.41),P=0.0004〕,indwelling catheter〔OR=2.88,95%CI(2.09,3.95),P<0.00001〕,frequency of intermittent catheterization≥2 times/week〔OR=2.44,95%CI(1.62,3.68),P<0.0001〕,frequency of bladder irrigation≥3 times/week〔OR=2.63,95%CI(1.66,4.17),P<0.0001〕,duration of bladder function training intervention≥2 weeks〔OR=2.75,95%CI(1.69,4.46),P<0.0001〕,duration of rehabilitation intervention>7 d〔OR=3.03,95%CI(1.42,6.48),P=0.004〕were associated with increased risk of urinary tract infection in neurogenic bladder;Male〔OR=0.78,95%CI(0.63,0.96),P=0.02〕was associated with decreased risk of urinary tract infection in neurogenic bladder.Conclusion Older age,complicated with diabetes,hypoalbuminemia,number of strokes≥2,indwelling catheter,frequency of intermittent catheterization≥2 times/week,frequency of bladder irrigation≥3 times/week,duration of bladder function training intervention≥2 weeks,and duration of rehabilitation intervention>7 d may be the risk factors for urinary tract infection in neurogenic bladder.To prevent or reduce the risk of urinary tract infection in these patients,clinical workers should identify the aforementioned high-risk factors as early as possible,and provide the patients with interventions targeting the controllable factors.
作者
何满兰
袁萍
何磊
陈璐
HE Manlan;YUAN Ping;HE Lei;CHEN Lu(Department of Neurosurgery,Nanjing Drum Tower Hospital/the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Drum Tower Clinical Medical College Affiliated to Jiangsu University,Nanjing 210008,China;Department of Nursing,Nanjing Drum Tower Hospital/the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《中国全科医学》
CAS
北大核心
2023年第21期2659-2665,共7页
Chinese General Practice
基金
江苏省医院管理研究创新项目(JSYGY-3-2021-190)
2020年南京市卫健委卫生科技重点发展项目(ZKX20012)
南京鼓楼医院院级课题(2022-B2135)。
