足跟部压力性损伤预防及管理的证据总结

Evidence summary for the prevention and management of Heel Pressure Injuries

目的:评价并整合国内外有关足跟部压力性损伤预防及管理的证据。方法:检索BMJ最佳临床实践(British Medical Journal Best Practice)、Cochrane图书馆、JBI循证卫生保健国际合作中心图书馆、加拿大安大略注册护士协会(RNAO)、美国指南网(NGC)、国际实践指南注册平台(中文),以及PubMed、Embase、中国知网、万方、中国生物医学文献数据库,补充检索泛太平洋地区压力性损伤联盟(PPPIA)、欧洲压疮咨询委员会(EPUAP)、美国国家压疮咨询委员会(NPUAP)、伤口造口失禁护士协会(WOCN)的官方网站,检索关于足跟部压力性损伤预防及管理的指南、证据总结、推荐实践、系统评价及专家共识等。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,评价不同类型研究的文献质量并评定其证据级别。结果:本研究共纳入12篇文献,其中1篇指南、6篇证据总结、3篇系统评价、1篇专家共识、1篇推荐实践。获取了23条证据并归纳为风险性评估、诊断性评估、使足跟“漂浮”(压力再分布)、保护足跟(敷料、保护装置)、治疗措施、建立跨学科团队6个方面。结论:医护人员应结合患者个体情况,按照相关级别的循证证据,选择最佳证据实施预防和管理,以提高足跟部压力性损伤管理的规范性和有效性。

Objective:To evaluate and integrate the best evidences on the prevention and management of Heel Pressure Injuries.Methods:We searched the BMJ Best Practice(British Medical Journal Best Practice),Cochrane Library,Joanna Briggs Institute Library,Registered Nurses'Association of Ontario(RNAO),National Guideline Clearinghouse(NGC),Guidelines International Network(GIN),and PubMed,Embase,CNKI,WanFang Data,CBM as well as the Pan Pacific Pressure Injury Alliance(PPPIA),European Pressure Ulcer Advisory Panel(EPUAP),National Pressure Ulcer Advisory Panel(NPUAP),Wound Ostomy and Continence Nurses Society(WOCN)as a supplement to collect literatures including guidelines,evidence summaries,recommended practice,systematic reviews and expert consensus on the prevention and management of Heel Pressure Injuries.The JBI evidence appraisal and recommendation system was used to evaluate the quality of studies and the level of evidences.Results:A total of 12 papers were brought into this study,including 1 guideline,6 evidence summaries,3 systematic reviews,1 consensus and 1 practice recommendation.Finally 23 pieces of best evidences were summarized,covering such 6 aspects as risk assessment,diagnostic assessment,"floating"heel(pressure redistribution),heel protection(dressing,protective device),treatment,and establishment of an interdisciplinary team.Conclusion:Medical staff should choose the best evidences to carry out clinical prevention and management of heel pressure injuries according to the individual situation of patients,in order to improve the standardization and effectiveness of the heel pressure injuries management.