脊髓损伤患者肢体痉挛护理管理的最佳证据分析

Optimal evidence analysis for the nursing management of limb spasm in patients with spinal cord injury

目的探讨脊髓损伤患者肢体痉挛护理管理的最佳证据。方法依据“6S”证据模型,系统检索中国知网、万方数据知识服务平台、PubMed、Cochrane Library等数据库和美国国家指南网、国际指南协作网、加拿大安大略注册护士协会等指南网,以及英国皇家医师学会、美国脊髓损伤协会、加拿大脊柱协会等专业协会网站。检索时限为建库至2022年7月。由2名研究者独立筛选与脊髓损伤患者肢体痉挛管理相关的文献,并进行质量评价及证据推荐级别评定。结果共纳入17篇文献,包括指南6篇、专家共识3篇、系统评价5篇、证据总结2篇、临床决策1篇,从评估鉴别、药物治疗(化学去神经法、口服药物)、康复训练(水疗康复、电刺激、磁刺激、振动疗法、冷热疗法、体位摆放、运动疗法)3个方面总结出30条证据。结论护理人员可依据临床环境组建多学科团队,综合脊髓损伤患者特点,围绕评估鉴别、药物治疗、康复训练等方面提供个性化干预措施,以期缓解其肢体痉挛程度。

Objective To explore the optimal evidence for the nursing management of limb spasm in patients with spinal cord injury.Methods Based on the"6S"evidence model,the databases including CNKI,Wanfang,PubMed and Cochrane Library,the guideline websites such as the National Guideline Clearinghouse,Guidelines International Network and Registered Nurses′Association of Ontario,and the websites of professional associations such as the Royal College of Physicians,American Spinal Injury Association and Canadian Spine Association were systematically searched.Search period of each database was set from the year of inception until July 2022.Two investigators independently screened the literatures related to the management of limb spasm in patients with spinal cord injury,and conducted quality evaluation and evidence recommendation level evaluation.Results Totally 17 literatures consisting of 6 guidelines,3 expert consensuses,5 systematic reviews,2 evidence summaries,and 1 clinical decision were included.Moreover,30 pieces of evidence were summarized from 3 aspects,including evaluation and identification,drug therapy(chemical denervation,and oral medication),rehabilitation training(hydrotherapy,electrical stimulation,magnetic stimulation,vibration therapy,heat and cold therapy,body position,and exercise therapy).Conclusion Nursing staff can set up a multidisciplinary team according to the clinical environment and take into consideration of the characteristics of spinal cord injury patients to provide personalized interventions involving evaluation and identification,drug therapy,rehabilitation training,etc.,so as to alleviate the degree of limb spasm.