骨科患者静脉血栓栓塞预防相关临床实践指南的质量评价和内容分析

Quality assessment and content analysis of existing clinical practice guidelines for the prevention of venous thromboembolism in orthopedic patients

目的:对国内外骨科静脉血栓栓塞(venous thromboembolism,VTE)预防相关临床实践指南进行质量评价和内容分析,为制定骨科患者标准化的预防方案提供依据。方法:检索国内外指南网及相关组织网站、数据库,按照纳入排除标准进行筛选,采用AGREEⅡ工具评价最终纳入的指南质量,分析各指南的特点。结果:共纳入9部骨科VTE预防相关指南,英文8部,中文1部。经AGREEⅡ评价的6个领域平均得分由高到低依次为:清晰性(74.07%)、范围和目的(70.06%)、参与人员(54.94%)、严谨性(41.67%)、应用性(40.97%)、独立性(40.28%)。纳入的指南涉及风险筛查、风险预警、预防策略、知识培训、知识转化等5个方面。结论:骨科VTE预防的相关指南总体质量一般,在严谨性、独立性和应用性领域有待提高。我国VTE预防发展起步较晚,尚缺乏基于循证的高质量临床实践指南。

Objective:To perform quality assessment and content analysis of clinical practice guidelines for the prevention of venous thromboembolism(VTE) in orthopedic patients issued in China and foreign countries,and to provide a basis for developing standardized prevention plans for orthopedic patients. Methods:Websites and databases of related networks and organizations were searched for related guidelines,and these guidelines were screened according to inclusion and exclusion criteria. Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ) was used to evaluate the quality of the guidelines included in this study,and the features of each guideline were analyzed. Results:A total of 8 English guidelines and 1 Chinese guideline concerning the prevention of VTE in orthopedic patients were included. According to AGREE Ⅱ,the domain of clarity of presentations had the highest mean score(74.07%),followed by scope and purpose(70.06%),stakeholder involvement(54.94%),rigor of development(41.67%),applicability(40.97%),and editorial independence(40.28%). The contents of these guidelines involved risk screening,risk warning,prevention strategies,knowledge training. and knowledge translation. Conclusion:The guidelines for VTE prevention in orthopedic patients have fair quality,and their rigor of development,editorial independence,and applicability remain to be improved. VTE prevention in China starts late and there is still a lack of high-quality evidence-based clinical practice guidelines.