经导管主动脉瓣置换术患者Ⅰ期心脏康复的最佳证据总结

Evidence summary of stage Ⅰ cardiac rehabilitation following transcatheter aortic valve replacement

目的总结经导管主动脉瓣置换术(transcatheter aortic valve repairment,TAVR)患者Ⅰ期心脏康复的最佳证据,为临床实践提供参考。方法计算机检索BMJ Best Practice、澳大利亚乔安娜布里斯格研究所(Joanna Briggs Institute,JBI)循证卫生保健研究中心、Cochrane Library、PubMed、医脉通、美国医疗保健与质量研究局(The Agency for Healthcare Research and Quality,AHRQ)、英国国家临床优化研究所(National Institute for Health and Care Excellence,NICE)指南库、中国知网、万方数据库、维普数据库中与TAVR心脏康复相关的临床指南、专家共识、证据总结、系统评价及Meta分析,并补充检索设计良好的随机对照试验。检索时限为建库至2020年08月30日。提取相关主题及证据,进行循证小组论证。结果本研究共纳入8篇文献,其中专家共识4篇、指南2篇、系统评价2篇,结合循证护理小组论证,汇总出22条TAVR患者Ⅰ期心脏康复的证据,包括评估、健康教育、预康复、早期运动、疼痛管理及应急管理6个方面。结论建议对拟行TAVR的患者尽早进行全面的康复评估,并在TAVR术后结合患者意愿及时调整康复方案,选择适合患者的最佳证据并执行。

Objective To summarize the best evidence of stageⅠcardiac rehabilitation following transcranial aortic valve replacement(TAVR)to provide reference for clinical practice.Methods We searched BMJ Best Practice,Joanna Briggs Institute(JBI)Evidence-based Healthcare Research Center,Cochrane Library,PubMed,Yimaitong,the Agency for Healthcare Research and Quality(AHRQ),National Institute for Health and Care Excellence(NICE)guideline library,China Knowledge Network,Wanfang database,VIP database on clinical guidelines,expert consensus,evidence summary,systematic review and meta-analysis related to cardiac rehabilitation of TAVR,and searched welldesigned randomized controlled trials to supplement the evidence.The search time limit was from the establishment of the database to August 30,2020.Extracted relevant topics and evidence,and conducted evidence-based group argumentation.Results A total of 8 articles were included in this study,including 4 expert consensuses,2 guide lines,and 2 systematic reviews.Combined with the judgment of the evidence-based nursing team,22 items of evidence on stageⅠcardiac rehabilitation after TAVR were summarized,including assessment and health education,pre-rehabilitation,early exercise,pain management and emergency management.Conclusion It is recommended that patients who intend to undergo TAVR treatment should receive a comprehensive rehabilitation assessment as soon as possible,and we should adjust the rehabilitation plan in time according to the patient’s wishes after TAVR,select the best evidence suitable for the patient and implement it.