急诊成人创伤性脊柱脊髓损伤患者脊柱固定护理的最佳证据总结

Evidence Summary of the nursing of spinal fixation in emergency adult patients with traumatic spinal cord injury

目的总结创伤性脊柱脊髓损伤患者脊柱固定管理的相关证据,为临床护理与照护提供参考。方法系统检索国内外数据库、相关指南网站等有关脊柱损伤的证据,文献类型为最佳实践、专家共识、系统评价、证据总结、临床决策等,检索时限为建库至2022年1月31日。由3名研究员采用多维系统评价工具评价系统评估类文献,5名研究员采用指南研究与评价工具评价临床实践指南,采用澳大利亚JBI循证卫生保健中心(2016)对专家意见和专业共识类文章的真实性评价工具进行专家共识和专家意见评价,对符合标准的文献进行资料提取和证据汇总。结果最终纳入文献10篇,包括临床决策4篇、指南4篇、系统评价2篇。最佳证据总结包括创伤脊柱脊髓损伤后的评估、预防、颈椎脊柱固定、管理等方面的内容,共30条。结论最佳证据强调,加强对所有急诊成人创伤性脊柱脊髓损伤患者颈椎风险因素的标准化评估,完善对颈部穿透性损伤患者脊柱评估固定能力,优化急诊全流程,降低潜在并发症发生,改善预后。

Objective To summarize the relevant evidence for the management of fixation in traumatic spinal cord injury patients,which provides a reference for the clinical care and care of patients.Methods A systematic search was conducted for evidence related to spinal injuries from domestic and foreign databases,relevant guideline websites,etc.The types of literature were best practice,expert consensus,systematic review,evidence summary,clinical decision-making,etc.The search time was from the establishment of databases to January 31,2022.Three researchers used the Multidimensional Systematic Review Tool to evaluate systematic review literature.Five researchers used the guideline research and evaluation tool AGREEⅡto evaluate clinical practice guidelines,and used the Australian JBI Evidence-Based Health Care Center(2016)to evaluate expert consensus and expert opinion with the authenticity evaluation tool for expert opinions and professional consensus articles.And extracted and summarized evidence according to the subject.Results Finally,10 articles were included,including 4 clinical decision-making,4 guidelines and 2 systematic evaluations.The 30 pieces of evidence include the assessment,prevention,cervical spinal fixation,and management after traumatic spinal cord injury.Conclusions The evidence emphasizes the importance of standardized assessment of cervical risk factors in all emergency adult patients with traumatic spinal cord injury.In the emergency department,we need to improve the ability of spinal evaluation and fixation in patients with penetrating neck injury,optimize the timeliness process of emergency trauma,reduce the occurrence of potential complications,and improve patient outcomes.