基于循证医学证据的《儿科输血指南》构建流程——以新生儿溶血病换血治疗的最佳换血量为例

The construction process of Guideline for Pediatric Transfusion based on evidence-based medicine—taking the optimal exchange transfusion volume for neonatal hemolytic disease as an example

儿童在血容量、血液组成成分水平、免疫系统成熟度以及机体对低血容量和缺氧的生理反应等方面不同于成人,其输血实践也较成人更为复杂。据此,国家卫生健康委员会发布了卫生行业标准《儿科输血指南》,其中换血治疗是新生儿溶血病的常用治疗策略。该文以新生儿溶血病的最佳换血量这一问题为例,探讨指南制定的循证流程,通过构建PICO、系统全面地检索文献、证据方法学质量评价、筛选以及评级,对该问题给出基于循证证据的推荐,为输血临床实践及指南制定提供有效的证据整理及评级方案,并阐述如何运用循证思维解决临床问题。

Children are different from adults in blood volume,blood component level,immune system maturity and physiological response to hypovolemia and hypoxia,and their transfusion practice is more complex than that of adults.In view of the above,the National Health Commission of the People’s Republic of China has issued the Guideline for Pediatric Transfusion,in which exchange transfusion therapy is a common treatment strategy for neonatal hemolytic disease.This paper takes the issue of the optimal exchange transfusion volume for neonatal hemolytic disease as an example to discuss the evidence-based process of the guideline formulation.The issue is recommended based on evidencebased medical proof through PICO[P(population/participants),I(intervention/exposure),C(comparator/control),O(outcome)]construction,systematic and comprehensive literature search,evidence evaluation,screening and rating.The purpose of this paper is to provide an effective evidence collation and rating scheme for transfusion clinical practice and guideline formulation,and to explain how to use evidence-based theory to solve clinical problems.