MHD患者营养管理的最佳证据总结

Summary of best evidence for nutritional management in MHD patients

目的检索维持性血液透析患者营养管理的相关证据,并汇总最佳证据。方法根据“6S”证据资源金字塔模型,检索有关维持性血液透析患者营养管理的所有证据资源类型,包括临床决策、临床实践指南、系统评价、专家共识以及各类原始研究。采用临床指南研究与评价系统Ⅱ、系统评价质量评估量表、JBI的文献评价标准和证据分级系统,对纳入文献进行质量评价及证据级别评定。结果本研究共检索出相关文献2695篇,最终纳入14篇文献,其中指南11篇、专家共识1篇、系统评价2篇。结合专业人员的判断,汇总了26条与维持性血液透析患者营养管理相关的证据,包括营养筛查与评估、营养干预、营养支持治疗、营养监测与随访4个方面。结论本研究总结了维持性血液透析患者营养管理的最佳证据,可为医务人员开展营养管理提供循证依据。医护人员应结合临床情况、患者偏好,有针对性地选择并应用最佳证据。

Objective This paper aims to search for relevant evidence on nutritional management in patients with maintenance hemodialysis and summarizes the best evidence.Methods According to the"6S"pyramid model of evidence resources,all types of evidence resources related to nutritional management in maintenance hemodialysis patients were searched,including clinical decision-making,clinical practice guidelines,systematic review,expert consensus,and various original studies.Clinical guideline research and evaluation system II,systematic evaluation quality assessment scale,JBI literature evaluation criteria,and evidence grading system were used to evaluate the quality of the included literature and to assess the evidence level.Results A total of 2695 relevant articles were retrieved in this study and 14 articles were finally included,including 11 guidelines,1 expert consensus,and 2 systematic reviews.Combined with professional judgment,26 items of evidence related to nutritional management of maintenance hemodialysis patients were summarized in four aspects:nutritional screening and evaluation,nutritional intervention,nutritional support therapy,nutritional monitoring,and follow-up.Conclusion This study summarizes the best evidence of nutritional management in patients with maintenance hemodialysis and can provide an evidence-based basis for medical staff to carry out nutritional management.Medical staff should target the selection and application of the best evidence in combination with clinical conditions and patient preferences.