透析中低血压预防与处理的最佳证据总结

Evidence summaries of prevention and management of intradialytic hypotension

目的:综合血液透析病人透析中低血压预防与处理的最佳证据,为医护人员开展临床循证实践提供参考。方法:检索各中英文数据库和专业协会网站有关与透析中低血压相关的专题证据汇总、临床实践指南、系统评价、证据总结、专家共识,检索时限为建库至2022年4月。由4名研究者对指南进行评价,其余文献由3名研究者进行评价,对纳入的文献进行证据提取并综合。结果:共纳入15篇文献,其中专题证据汇总1篇、指南3篇、系统评价6篇、证据总结2篇、行业标准1篇、专家共识2篇。总结了8个方面的最佳证据,包括基本特征、风险评估、一线预防方案、二线预防方案、三线预防方案、辅助预防措施、全程血压监测、应急处理措施,共29条证据。结论:医疗机构应基于证据建立血液透析病人透析中低血压预防的管理标准,建议医务人员针对病人相关风险因素规范落实阶梯式的三线预防方案和辅助预防措施,同时做好全程血压监测,及时发现透析中低血压,从而科学快速地处理以减少其导致的伤害,保证病人安全。

Objective:To summarize the best evidence for prevention and management of hypotension in maintenance hemodialysis patients,in order to provide references for medical staff to carry out clinical evidence-based practice.Methods:Relevant evidence-based databases and professional association websites in both Chinese and English were retrieved for IDH related thematic evidence summaries,clinical practice guidelines,system evaluations,evidence summaries,and expert consensus.The retrieval time was from the inception to April 2022.Four researchers evaluated the retrieved guidelines,and three researchers evaluated the rest of the literature.Evidence was extracted and integrated for the literature that met the quality standards.Results:A total of 15 articles were included,including 1 clinical decision,3 guidelines,6 systematic reviews,2 evidence summary,1 industry standard,and 2 expert consensuses.Summarize the evidence of 29 items in 8 aspects,including basic characteristics,risk assessment,organizational construction,third-line prevention plan,supplementary preventive measures,whole process blood pressure monitoring,and emergency management.Conclusion:Medical institutions should establish management standards for the prevention of hypotension during dialysis in hemodialysis patients based on evidence.It is recommended that medical staff implement a step-by-step third-line prevention plan and auxiliary preventive measures according to the relevant risk factors of patients.At the same time,blood pressure monitoring should be done throughout the whole process to detect hypotension in dialysis in time,so as to deal with it scientifically and quickly to reduce the harm caused by it and ensure the patient′s safety.