心脏瓣膜置换术后病人自我管理的最佳证据总结

Summary of the best evidence for patient self-management after heart valve replacement

目的:检索及汇总成人心脏瓣膜置换(HVR)术后病人自我管理内容的相关证据,并对证据进行分析总结。方法:按照“6S”证据模型自上而下检索国内外数据库关于HVR术后病人自我管理的证据,包括临床决策、指南、证据总结、推荐实践、系统评价及专家共识。检索时间为建库至2022年2月28日。结果:共纳入16篇文献,其中临床决策1篇,指南4篇,专家共识5篇,系统评价6篇,总结了目前关于HVR术后病人自我管理的最佳证据,包括口服抗凝治疗、预防术后胸骨撑开与感染、自我检测瓣膜功能、心脏彩超的随访频率、心脏康复运动、焦虑抑郁情绪管理、应急求助、注意事项8个方面,共43条证据。结论:基于该证据总结,医护人员在综合临床情况及病人意愿后,可构建成人HVR术后规范化自我管理的指导方案,以提高病人自我管理能力。

Objective:To search and summarize the relevant evidence of self-management after adult heart valve replacement(HVR),and to analyze and summarize the evidence.Methods:According to the "6S" evidence model, the evidence of HVR postoperative patient self-management was searched from domestic and foreign databases, including clinical decision, guidelines, evidence summary, recommended practice, systematic evaluation and expert consensus.The retrieval time was from the establishment of each datebase to February 28,2022.Results:A total of 16 articles were included, including 1 clinical decision, 4 guidelines, 5 expert consensus and 6 systematic reviews.The best evidence on the self-management of patients after HVR surgery was summarized, including 43 pieces of evidence in 8 aspects, including oral anticoagulant therapy, prevention of postoperative sternal spasm and infection, self-testing of valve function, frequency of follow-up of cardiac color doppler ultrasound, cardiac rehabilitation exercise, anxiety and depression management, emergency help and precautions.Conclusions:Based on the summary of the evidence, medical staff can construct a standardized self-management guidance program for adult heart valve replacement after comprehensive clinical conditions and patients′ wishes, so as to improve patients′ self-management ability.