维持性血液透析患者容量负荷评估与管理的最佳证据总结

Summary of the best evidence for the assessment and management of volume load in maintenance hemodialysis patients

目的检索维持性血液透析患者容量负荷评估与管理的证据,并对证据进行总结,为医护人员对该类患者进行容量负荷评估与管理提供循证依据。方法检索WHO指南库、英国国家卫生与临床优化研究所网站、国际指南协作网、美国国立临床诊疗指南数据库、苏格兰大学校际指南协作网、Cochrane Library、BMJ Best Practice、UpToDate、医脉通、PubMed、Web of Science、Embase、CINAHL、中国知网、万方医学网、维普、中文生物医学期刊数据库等网站、指南库、数据库中关于维持性血液透析患者容量负荷评估与管理的证据,包括指南、证据总结、最佳实践、系统评价、Meta分析及原始研究。检索时限为2015年1月—2020年12月。筛选文献并进行质量评价,提取及归纳总结证据。结果最终纳入文献11篇,其中指南8篇,系统评价3篇。总结出容量负荷评估方法、干体重评估及优化、血压控制及药物使用、钠摄入及排出、饮食评估和水分控制、透析频率及时间、生物阻抗设备的使用7个方面,共19条最佳证据。结论在维持性血液透析患者容量负荷评估中,可采用多学科共同决策的评估方法。在实际应用中,医护人员需结合具体的临床情境及患者意愿,选择最佳证据。

Objective To retrieve the relevant evidence for the assessment and management of volume load in maintenance hemodialysis(MHD)patients,and to summarize the best evidence,so as to provide evidence-based bases for medical staff to evaluate the volume load of MHD patients.Methods The guideline database and comprehensive database were searched,including WHO Guidelines,NICE,GIN,AHRQ,SIGN,Cochrane Library,BMJ Best Practice,UpToDate,Yimaitong,PubMed,Web of Science,Embase,CINAHL,CNKI,Wanfang,Med Online,CMJD.All the evidence were searched on assessment of volume load in MHD patients,including guidelines,evidence summaries,best practice,systematic evaluations,meta analysis and original research.The retrieval time was from January 2015 to December 2020.The literature was screened and evaluated,in order to summarize the best evidence.Results 11 articles were finally included,including 8 guidelines and 3 systematic reviews(including meta-analysis).19 pieces of best evidence were summarized in 7 aspects including volume load assessment methods,dry weight assessment and optimization,blood pressure control and drug use,sodium intake and elimination,diet assessment and fluid restriction,dialysis frequency and time,and the use of bio-impedance equipment.Conclusion In the assessment of volume load in MHD patients,a multidisciplinary assessment method of shared decision making is practical.In clinical practice,medical staff should select the best evidence based on specific clinical situations and patient wishes.In order to improve the accuracy of the assessment of volume load in MHD patients,a scientific,effective,and easy-to-use comprehensive assessment method and capacity management measure is meant to be further studied.