预防关节置换术后患者发生深静脉血栓的最佳证据总结

Evidence summary for prevention of deep venous thrombosis in patients after joint replacement

目的全面检索和分析关节置换术后患者深静脉血栓预防的护理相关证据,并对最佳证据进行总结。方法使用计算机检索BMJ Best Practice、UpToDate、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、医脉通、国际指南协作网、美国国立指南文库、新西兰指南小组网站、英国国家卫生与临床优化研究所网站、苏格兰校际指南网络、国家健康和医学研究理事会-澳大利亚临床实践指南网、加拿大医学会临床实践指南信息库、护理和相关医学文献累计索引、荷兰医学文摘数据库、PubMed、Web of Science核心数据库、万方和中国知网数据库中预防关节置换术后患者发生深静脉血栓护理相关的临床决策、证据总结、指南、专家共识,检索时限为2015年1月—2020年11月。由2名研究人员对文献质量进行独立评价,并依据澳大利亚乔安娜布里格斯研究所循证卫生保健中心证据预分级系统(2014版)进行证据分级。结果共纳入文献13篇,包括临床决策3篇、证据总结2篇、指南4篇、专家共识4篇。结合专业人员的判断,围绕风险评估、健康宣教、基本预防、物理预防、药物预防、促进预防措施的临床落实6个方面,共汇总16条最佳证据。结论该研究总结的预防关节置换术后患者发生深静脉血栓的最佳证据较为全面、科学,可为临床护理工作的开展提供循证依据。

Objective To comprehensively retrieve and analyze evidence related to deep vein thrombosis(DVT)prevention after joint replacement and to summarize the best evidence.Methods We systematically searched for evidence on DVT prevention after joint replacement in BMJ Best Practice,UpToDate,JBI,YiMaiTong,GIN,NGC,NZGG,NICE,SIGN,NHMRC,CPG Infobase,CINAHL,EMBASE,PubMed,WOS,Wanfang and CNKI databases to collect relevant clinical decisions,evidence summaries,clinical guidelines and expert consensuses.The timeframe of data search ran from January 2015 to November 2020.2 researchers independently evaluated the quality of the articles,and classified the evidence according to the Joanna Briggs Institute evidence-based pre-grading system(2014 edition).Results A total of 13 articles were included,including 3 clinical decisions,2 evidence summaries,4 guidelines and 4 expert consensuses.Combined with professional judgment,16 pieces of best evidence in 6 aspects were summarized,including risk assessment,health education,preventive measures of nursing care,mechanical prophylaxis,pharmacological prophylaxis,and promotion of clinical implementation of preventive measures.Conclusion The best evidence summarized on the prevention of DVT in patients after joint replacement can provide evidence for clinical nursing work.