预防成人术中获得性压力性损伤的最佳证据总结

Evidence summary of prevention of intraoperative acquired pressure injury in adult patients

目的检索、评价并整合国内外预防成人术中获得性压力性损伤的相关证据,并对最佳证据进行总结。方法检索加拿大安大略注册护士协会、英国国家卫生与临床优化研究所、苏格兰学院间指南网、美国指南网、国际指南网、医脉通、British Medical Journal最佳临床实践、UpToDate、Cochrane Library、乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)Library、PubMed、CINAHL、荷兰医学文摘数据库、中国知网、万方数据库、美国压力性损伤咨询小组官网、美国伤口造口失禁护理协会、美国围手术期注册护士协会等网站的相关指南、系统评价和专家共识。检索时间为建库至2019年12月。采用澳大利亚JBI循证卫生保健中心的文献评价标准和证据分级系统,对不同类型研究进行文献质量评价及证据级别评定。结果共纳入文献17篇,其中指南4篇,专家共识1篇,系统评价12篇。结合临床专家判断,总结了27条预防成人术中获得性压力性损伤的证据,包括风险评估、皮肤和组织评估、体位管理、患者交接、体温管理及教育和培训等。结论应结合证据形成多科室联合和多学科合作的预防方案。在证据转化时,结合医院特点和临床环境,有针对性地选择最佳证据,规范患者管理,以降低术中获得性压力性损伤的发生率。

Objective To collect,evaluate and integrate the available evidence of prevention of intraoperative acquired pressure injury,and summarize the best evidence.Methods Registered Nurses’Association of Ontario,National Institute for Health and Clinical Excellence,Scottish Intercollegiate Guidelines Network,National Guideline Clearinghouse,Guidelines International Network,Medlive.cn,British Medical Journal Best Practice,UpToDate,Cochrane Library,Joanna Briggs Institute Library,PubMed,CINAHL,Embase,CNKI,WanFang Data,National Pressure Injury Advisory Panel,Wound Ostomy and Continence Nurses Society,the Association of perioperative Registered Nurses were researched to collect literatures including guidelines,systematic reviews and consensuses.The time limit for the retrieval is from the inception of databases until Decemeber 2019.The JBI evidence appraisal and recommendation system was used to evaluate the quality of studies and the level of evidence.Results 17 pieces of literature were retrieved,including 4 guidelines,12 systematic reviews and 1 consensus.Combined with the judgment of clinical experts,totally 27 peices of evidence were summarized,including risk assessment,skin assessment,position management,patient handover,temperature control,education and training,etc.Conclusion The prevention program of multi-section joint and multi-discipline cooperation should be formed according to the evidence.In the application and implementation of evidence,the best evidence should be selected according to the characteristics of the hospital and the clinical environment,and the management of patients should be standardized to reduce the incidence of intraoperative acquired pressure injury.