危重症住院患者失禁相关性皮炎预防及护理的最佳证据总结

Summary of best evidence for prevention and care of incontinence associated dermatitis among critically ill inpatients

目的检索分析并总结成人危重症住院患者失禁相关性皮炎预防及护理的相关证据,为临床护理人员对失禁相关性皮炎展开规范化预防和管理提供依据。方法应用循证护理的方法,针对成人危重症住院患者失禁相关性皮炎护理提出问题,并检索近10年内失禁相关性皮炎的相关研究,检索数据库依次为:Best practice、美国指南网(NGC)、澳大利亚循证卫生保健中心(JBI)证据总结数据库、Cochrane数据库,并补充了原始文献数据库PubMed、CINAHL数据库和中国生物医学文献数据库(CBM)。采用英国2012年更新的《临床指南研究与评价系统》(AGREEⅡ)、JBI的文献质量评价工具对各类研究进行文献质量评价及证据级别评定。结果总结出在特定临床情景下具备可行性及适宜性的证据18条,包括失禁相关性皮炎的识别与评估、大小便收集产品的选择、失禁相关性皮炎皮肤护理方法等方面。结论建议临床科室在对证据进行应用时,需要评估所在医疗机构的临床环境/条件、医务人员应用证据的促进因素及阻碍因素、患者意愿及偏好等有针对性地选择证据。同时,由于最佳证据随着时间的推移不断更新,应用者还需持续对证据进行更新,应用最佳证据。

Objective To retrieve,analyze and summarize the available evidences on prevention and care of incontinence associated dermatitis among critically ill adult inpatients,and to provide references for clinical nurses to carry out standardized prevention and management of incontinence associated dermatitis.Methods The nursing problems of incontinence related dermatitis among critically ill adult inpatients were raised using evidence-based nursing,and related studies of incontinence associated dermatitis in the past 10 years were searched.Database retrieved were as follows：Best practice,American Guide（NGC）,Australia based health care center syndrome（JBI）evidence summary database,Cochrane database,and the original literature databases PubMed,CINAHL database and China biomedical literature database（CBM）were added.The quality and grade of various studies were evaluated using the2012 updated《clinical guidelines research and evaluation system》（AGREE II）and the literature quality evaluation tool of JBI.Results A total of 18 evidences which were feasible and suitable in particular clinical context were summarized,including identification and assessment of incontinence associated dermatitis,selection of fecal and urine collection products and skin care methods etc.ConclusionIt is recommended that when applying the evidences in clinic,it is necessary to assess the clinical environment/conditions,the promoting factors and obstructing factors for clinical staff use the evidence,patients′willingnesses and preferences to select evidences accordingly.Meanwhile,as the best evidence update over time,it is necessary to update and apply the best evidence continuously.