中国先天性心脏病患儿术后危重程度评估现况的系统分析与启示

Systematic analysis and revelation of current situation of postoperative severity degree evaluation for children patients with congenital heart diseases in China

目的 了解中国先天性心脏病（以下简称先心病）患儿术后应用危重程度评估的现况及所面临问题,为提高临床危重预测与护理能力提供参考.方法 检索Cochrane图书馆、PubMed、EMbase、CINAHL、CBMdisc、CNKI、万方、维普数据库,语种不限,纳入2000—2016年公开发表文献.纳入与先心病患儿术后危重程度评估相关文献,经3名研究者应用QUADAS评价系统评鉴文献质量并提取资料,完成文献分析.结果 共纳入文献12篇.其中仅2篇发表于护理类期刊;普适评估工具应用人群以呼吸系统疾病为主,仅1篇文献以先心病为研究对象;工具应用效果存在较大差异,普适工具应用于先心病效果受限,2项研究显示特异性评分应用效果尚可,但仍缺乏多中心、大样本验证.结论 中国先心病患儿术后危重程度评估工具应用有限,护理人员重视程度并不高,欠缺相关验证性研究.对于特异性评分,有待更深入的研究.建议在验证工具应用效果的基础上,结合护士培训,协力推广工具的合理应用,保障患儿安全.

Objective To understand the current postoperative application situation of severity degree evaluation for children patients with congenital heart diseases （CHD） in China and the confronting problems,in order to offer reference to improve clinical severity prediction and nursing ability.Methods Cochrane Library, PubMed,EMbase,CINAHL,CBMdisc,CNKI,Wanfang database and VIP database were searched. Languages were not limited. The literature which was published from 2000 to 2016 was included. The literature which was related to postoperative severity degree evaluation for the children patients with CHD was included. The quality of included literature was critically evaluated and the data were extracted with QUADAS evaluation system by three reviewers. They also completed the literature analysis.Results Twelve articles were included. There were only 2 articles published in nursing journals. Pervasive evaluation methods were mainly applied in the people with diseases of respiratory system. There was only 1 article which studied CHD. The application effects of evaluation methods were different. The application effect of pervasive evaluation methods in CHD was limited. Two studies showed that the application effect of the specific score was good,but there was no multicenter or large sample verification.Conclusions The application of postoperative severity degree evaluation methods for children patients with CHD in China is limited. The recognition degree of nurses is not high. Relative verification research is not enough. Further studies of the specific score are necessary. We suggest that the reasonable application of evaluation methods should be promoted based on verifying the application effects of evaluation methods and in combination with the training of nurses,which guarantees the safety of children patients.