缺血性脑卒中患者静脉血栓栓塞症非药物预防与管理的最佳证据总结

Summary of best evidence for nonpharmacologic prevention and management of venous thromboembolism in patients with ischemic stroke

目的检索、评价并汇总缺血性脑卒中患者静脉血栓栓塞症(VTE)非药物预防与管理的最佳证据。方法按照"6S"模型计算机检索Best Practice、UpToDate、澳大利亚乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心数据库、PubMed、CINAHL、中国生物医学文献服务系统、中国知网、万方数据库、维普网以及国内外卒中专业网站关于缺血性脑卒中患者静脉血栓栓塞症非药物预防与管理的证据,包括临床决策、最佳实践、证据总结、指南、系统评价、专家共识及随机对照试验,检索时限为建库至2022年3月20日。对文献进行质量评价、证据提取与汇总。结果共纳入19篇文献,包括临床决策2篇、证据总结2篇、指南8篇、系统评价3篇、专家共识4篇。汇总组织保障、风险评估、筛查与诊断、基本预防、机械预防与健康教育6个方面共38条最佳证据。结论本研究总结了缺血性脑卒中患者VTE非药物预防与管理的最佳证据,建议结合临床情境、证据应用的促进因素、阻碍因素及患者意愿,通过多学科协作,科学、有计划地推进证据的临床应用。

Objective To retrieve,review and summarize the best evidence on nonpharmacologic prevention and management of venous thromboembolism(VTE)in patients with ischemic stroke(IS).MethodsAccording to the"6S"model,Best Practice,UpToDate,Joanna Briggs Institute(JBI)Evidence-Based Health Care Center Database,PubMed,CINAHL,SinoMed,CNKI,Wanfang,VIP Databases,and dedicated stroke websites in China and abroad were searched for the evidence of nonpharmacologic prevention and management of VTE in IS patients,including clinical decision-making,best practice,evidences summary,guidelines,systematic reviews,expert consensus and randomized controlled trials published up to March 20,2022.Evidence was extracted and summarized after quality assessment of the literature.ResultsA total of 19 articles were included,including 2 clinical decision-making articles,2 evidences summaries,8 guidelines,3 systematic reviews,and 4 expert consensus.A total of 38 pieces of best evidence were collected from 6 aspects:organizational security,risk assessment,screening and diagnosis,basic prevention,mechanical prevention and health education.ConclusionsThis study summarizes the best evidence for nonpharmaceutical prevention and management of VTE in IS patients.It is recommended to promote the clinical application of this evidence scientifically and in a planned way through multidisciplinary collaboration in combination with clinical situations,factors promoting and hindering the application of evidences,and patient wishes.