慢性肾脏病患者妊娠管理相关指南的质量评价及内容分析

Quality Evaluation and Content Analysis of Pregnancy Management Guidelines for Patients with Chronic Kidney Disease

目的系统评价慢性肾脏病患者妊娠管理相关临床指南,为制订慢性肾脏病患者妊娠管理规范提供依据。方法检索国内外文献数据库、专业学会网站和指南发布主要网站。由2名研究者独立进行文献的筛选和资料提取后,分别使用AGREEⅡ和澳大利亚JBI循证卫生保健中心专家共识评价标准评价循证指南和专家共识指南,并比较分析各指南的推荐内容。结果共纳入9篇相关临床指南,其中循证指南3篇,专家共识指南6篇。循证指南均来自国外,l篇循证指南的总体质量评价为A级,2篇为B级,指南整体质量较高;基于专家共识的指南6篇,总体评价结果均为“纳入”。最终总结的慢性肾脏病患者妊娠管理相关推荐意见涉及孕前咨询与管理、妊娠期管理(涉及血压、饮食、随访)、产后管理3个方面26条推荐意见。结论纳入的慢性肾脏病患者妊娠管理相关指南质量整体较高,但部分争议性问题有待进一步研究,需尽快开发适合我国慢性肾脏病患者妊娠管理循证指南。

Objective To evaluate the clinical guidelines related to pregnancy management in patients with chronic kidney disease(CKD), and to provide reference for the development of pregnancy management norms in patients with CKD. Methods The included guidelines collected from guideline websites, professional society website and electronic databases were evaluated and analyzed.Evaluation of evidence-based guideline, and expert consensus guideline were assessed by AGREE Ⅱ and expert consensus assessment criteria(2017) of the JBI evidence-based health care center respectively, and the recommendations of each guideline were summarized and analyzed. Results A total of 9 clinical practice guidelines were included, including 3 evidence-based guidelines and 6 expert consensus guidelines, all of which were from abroad. In terms of overall quality, there were 1 grade-A and 2 grade-B evidence-based guidelines. The overall quality of the guideline was relatively high. The overall evaluation of the 6 guidelines based on expert consensus was “inclusion”. The recommendations for pregnancy management of patients with CKD involved 3 aspects: consultation and management before pregnancy, pregnancy management, and postpartum management. Conclusion The quality of the clinical guidelines for pregnancy management in CKD patients is generally high, but some controversial issues need to be further studied. It is necessary to develop evidence-based guidelines for pregnancy management of Chinese patients with CKD as soon as possible.