目的:高磷血症是维持性血液透析(MHD)最常见的并发症之一,严重影响患者的身心健康,饮食控制是重要的降磷方式,本文的目的是系统性评估强化教育对MHD患者高磷血症的影响. 方法:系统检索Medline、Embase、Cochrane图书馆,截止时间为2018-01-15,检索词包括“patient education”、“hemodialysis”、“hyperphosphatemia"和“randomized controlled trial”等.使用Jadad量表对纳入文献进行方法学质量评价,提取有效数据后使用Revman 5.3进行数据分析,主要结局指标包括血清钙、磷、钙磷乘积和知识评分等相关指标. 结果:最终纳入10个随机对照试验包括908例患者,Meta分析结果显示,和对照组相比,强化教育可显著升高患者血清钙水平(WMD=0.07,95％CI:0.02～0.12,P＜0.01),降低患者血磷水平(WMD=-0.20,95％CI:-0.32-0.09,P＜0.01)和钙磷乘积(WMD=-0.62,95％CI:-0.86-0.38,P＜0.01),并显著提高患者的知识得分(SMD=0.78,95％CI:0.06～ 1.51,P=0.03).根据教育实施者不同进一步行亚组分析,结果显示和非营养师教育相比,营养师教育组患者在降低血磷方面效果更佳,两组之间差异具有统计学意义(P=0.03). 结论:强化教育可显著降低MHD患者血清磷水平,同时提高血清钙水平和患者知识得分,提高患者对疾病的认知程度,有助于改善患者生活质量,营养师教育在患者教育中成效显著,在后期的患者管理中可进一步推广.%Objective:Hyperphosphatemia,one of the most common complications of maintenance hemodialysis (MHD),significantly affected the outcomes of patients.Diet control was an important way to reduce serum phosphorus.The purpose of this study was to systematically evaluate the effect of intensive education on hyperphosphatemia in MHD patients.Methodology:By searching on Medline,Embase and Cochrane library,the key words included "patient education","hemodialysis","hyperphosphatemia" and "randomized controlled trial",deadline was January 15,2018.The methodological quality of the included literatures was evaluated by Jadad scale,and valid data was collected or extracted for the meta-analysis through using Revman 5.3 Software.The main outcome measures included serum calcium,phosphorus,calcium×phosphorus products and knowledge scores.Results:Total 10 RCTs of 908 patients were included in this metaanalysis.The results showed that intensive education could significantly increase the level of serum calcium (WMD =0.07,95％ CI:0.02-0.12,P＜0.01);decrease the level of serum phosphorus (WMD=-0.20,95％ CI:0.32～-0.09,P＜0.01)and the calcium × phosphate product (WMD =-0.62,95％ CI:-0.86-0.38,P ＜ 0.01),and significantly improve the knowledge score of patients (SMD =0.78,95％ CI:0.06 ～ 1.51,P =0.03),while compared with the control group.The subgroup analysis was conducted according to the different educational implementers.The results showed that compared with non-nutritionist education,the dietitian education group was better in reducing serum phosphorus,the difference was statistically significant (P=0.03).Conclusion:Intensive education can significantly reduce serum phosphorus levels in patients with MHD,while increasing serum calcium levels and knowledge scores,nutritionist education has achieved remarkable results in patient education and could be further promoted in patient management.
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