急性缺血性卒中相关性肺炎的管理相关循证指南的AGREEⅡ质量评价

Quality Evaluation of Clinical Practice Guidelines for Management of Acute Ischemic StrokeAssociated Pneumonia: a Study Based on AGREE Ⅱ

目的评价预防急性缺血性卒中相关性肺炎相关指南的质量,为科学系统制定我国的临床指南提供参考。方法按照纳入、排除标准纳入数据库及网站检索的国内外有关预防急性缺血性卒中相关性肺炎的临床指南,并按照国际公认的指南评价工具(Appraisal of Guidelines for Research and EvaluationⅡ,AGREEⅡ)进行质量评价,并分析各指南推荐内容的异同。结果共纳入8篇指南,国内3篇,国外5篇。对纳入指南进行6个维度(范围和目的、参与人员、严谨性、清晰可读性、应用性、撰写的独立性)评价的平均得分分别为100%、39.58%、60.18%、36.46%、41.67%、56.25%,2名评价者对8篇指南的评价结果Kappa值均等于0.75(均P<0.05),具有极好的一致性。Guidelines for the early management of patients with acute ischemic stroke及Management of patients with stroke:identification and management of dysphagia两部指南的推荐等级为A级,质量最佳;共有5篇指南推荐等级为B级;国内中文指南有1篇质量较低,推荐等级为C级;纳入的8篇指南均未单独制定出卒中相关性肺炎的最佳实践指南。结论纳入的国外指南总体质量较高,国内指南的严谨性及编辑独立性等诸多方面距离国际标准仍有一定差距,且8篇指南存在的最大问题为均未考虑患者方的意愿。现有的国内外指南均以卒中或吞咽为主,并未制定出预防急性缺血性卒中相关性肺炎的指南,其针对性较低。

Objective To evaluate the quality of acute ischemic stroke-associated pneumonia(AISAP)related guidelines,and provide a reference for developing the clinical guidelines for AISAP scientifically and systematically in China.Methods According to the inclusion and exclusion criteria,the domestic and international AISAP related guidelines searched in the database and websites were included in this study.All the guidelines were evaluated for the quality according to the Appraisal of Guidelines for Research and EvaluationⅡ(AGREEⅡ),and the similarities and differences among the recommendations of the guidelines were analyzed.Results A total of 8 guidelines were included,with 3 Chinese and 5 international ones.The total scores of the six dimensions(scope and purpose,participants in the development of guidelines,rigor,clarity and readability,applicability,and editorial independence)for all the guidelines were 100%,39.58%,60.18%,36.46%,41.67%,56.25%,respectively.The Kappa values of the two evaluators for the 8 guidelines were both equal to 0.75(both P<0.05),with excellent consistency.The class of recommendations of two guidelines was class A—Guidelines for the early management of patients with acute ischemic stroke and Management of patients with stroke:identification and management of dysphagia,with the best quality;the class of five guidelines was class B,and the class of one Chinese guideline was class C,with the worst quality.None of the included guidelines specially developed the best practice recommendations for AISAP management.Conclusions The overall quality of the foreign guidelines was relatively high,and the domestic guidelines were inferior to the foreign ones in many aspects such as the rigor and editorial independence.The biggest problem for the 8 guidelines was that they all did not consider the wishes of the patients.The current domestic and international guidelines mainly focused on stroke or swallowing,with no guideline specially for AISAP.