脑卒中后认知障碍病人筛查与管理最佳证据总结

Summary of the best evidence for screening and management of patients with post⁃stroke cognitive impairment

目的:总结脑卒中后认知障碍病人管理的相关证据,为临床医护人员早期识别、评估、干预及健康教育提供依据。方法:应用循证护理方法,针对成人脑卒中后认知障碍管理提出问题,检索UpToDate、澳大利亚循证卫生保健中心(JBI)证据、美国指南网(NGC)、Cochrane Library、EBM Guidelines数据库、PubMed、MedLine、中国知网、万方数据库和中国生物医学文献数据库关于脑卒中后认知障碍管理的相关指南、证据总结、临床决策、推荐实践、系统评价、专家共识等,根据英国2012年版《临床指南研究与评价系统》(AGREE-Ⅱ)、AMSTAR以及JBI的各类文献质量评价工具对纳入文献进行文献质量评价及证据级别的评定。结果:综合专业人员的判断,总结出脑卒中后认知障碍的早期筛查、评估、药物干预、非药物干预及健康教育5个方面共31条适宜性证据等。结论:脑卒中后认知障碍管理的最佳证据可为临床医护人员提供循证依据,提升脑卒中后认知障碍的综合管理水平,提高病人照护质量。

Objective:To summarize the relevant evidence for the management of patients with post⁃stroke cognitive impairment,and to provide a basis for early identification,evaluation,intervention,and health education for clinical medical staff.Methods:Apply evidence⁃based nursing methods to raise questions about the management of post⁃stroke cognitive impairment in adults.The relevant guidelines,evidence summary clinical decisions,recommend practice,systematic evaluation and expert consensus on the management of post⁃stroke cognitive impairment was retrieved from Up To Date,Joanna Briggs Institute(JBI),National Guideline Clearinghouse(NGC),Cochrane Library,EBM Guidelines,PubMed,MedLine,China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Biomed⁃ical Literature Database.According to the 2012 edition of the Appraisal of Guidelines for Research and Evaluation(AGREEⅡ),AMSTAR,and multiple literature quality evaluation tools from JBI,the evaluation on the literature quality and the level of evidence for included literature were conducted.Results:Based on the judgment of professionals,a total of 31 pieces of evidence of suitability for post⁃stroke cognitive impairment were summarized,including 5 aspects,which were early screening,evaluation,medication intervention,non⁃medication intervention and health education.Conclusions:The best evidence for the management of post⁃stroke cognitive impairment could provide evidence⁃based evidence for clinical nurses,improve the comprehensive management level and quality of nursing for patients with post⁃stroke cognitive impairment.