国际产科脓毒症临床指南系统比较研究

Clinical Practice Guidelines on Maternal Sepsis:A Systematic Review

目的：系统评价国际产科脓毒症临床指南,以期为临床应用提供参考。方法：计算机检索多种数据库建库以来至2015年4月30日的文献,独立采用临床指南研究与评估（AGREE）Ⅱ工具评价指南的制定和报告质量。结果：①最终纳入4篇指南,时间跨度2012~2014年,包括英国2篇,爱尔兰1篇,澳大利亚1篇,我国尚无产科脓毒症的指南。②纳入指南AGREEⅡ领域得分较高的是＂范围和目的＂（67.91%）,＂清晰性＂（62.50%）。爱尔兰和英国指南为B,澳大利亚指南为C。③4篇指南均涉及产科脓毒症的病因和治疗。澳大利亚指南和爱尔兰指南均明确指出孕产妇与非孕妇成人脓毒症的炎症诊断标准不同;澳大利亚指南提出了脓毒症除细菌之外的多种病原体来源;仅英国指南给出了鉴别诊断和抗菌药物使用的详细意见;对静脉免疫球蛋白的使用,英国和爱尔兰指南给出了不同意见;英国指南还涉及孕产妇的病情监测、转诊以及胎婴儿的处理、脓毒症的预防等。结论：迄今为止尚无统一的国际产科脓毒症指南,专科指南系统评价质量不高,各指南中重点侧重点不同,对我国产科脓毒症临床处理和指南的制定有一定借鉴作用。

Objective：To systematically evaluate the quality of existing guidelines of maternal sepsis in the world,and provide references for clinical practice. Methods ：Guidelines concerning maternal sepsis were electroni- cally retrieved from multiple databases. All the data were searched from inception of the database or network to 30 th April 2015. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, and assessed the quality of guidelines using the AGREE II. Results：A total of 4 guidelines concerning maternal sepsis released by UK,Ireland and Australia from 2012 to 2014 were eligible. No guidelines on maternal sepsis have been developed in China. These guidelines covered the definition, risk, diagnosis, key management ,fatal and neonatal monitoring,treatment, and prevention. Among 4 guidelines, almost all general recommendations from 4 guidelines are likely same as international guideline, and UK and Australia guidelines were more specifically invol- ving maternal sepsis and fetal and newborn monitoring. The high scores of guidelines according to the domains of AGREE U are ＇ scope and purpose＇ （~67. 91%） and ＇ Clarity of presentations＇ （62.50%）. The general levels of recommendations were Level B（ Ireland guidelines and UK guidelines） and level C（Australia guideline）. The rec- ommendations of different guidelines were different in context and levels. The 4 guidelines all reviewed the etiolo- gy and treatment of obstetric sepsis. The Australian guidelines and Irish guidelines have made clear that the crite- ria for the diagnosis of sepsis in maternal and non pregnant adults are different. The Australian guidelines suggest various sources of pathogens in addition to bacteria. The UK Guidelines provide the details of the identification and use of antibiotics. The UK and Ireland guidelines give different opinions on the use of intravenous immuno- globulin. The UK guidelines also include maternal monitoring, referral and treatment of fetal and babies, prevention of sepsis and so on. Conclusions：The guidelines on maternal sepsis are incongruent and the maternal recom- mendation is considered of insufficient quality. Guidelines are recommended to be developed on the basis of the methods of evidence-based medicine, and best evidence is recommended. National organizations should be es- tablished in China and strengthen the high-quality evidences.