肺癌患者免疫检查点抑制剂相关皮肤毒性预防及护理的最佳证据总结

Summary of evidence on prevention and nursing of immune checkpoint inhibitor associated skin toxicity in lung cancer patients

目的总结肺癌患者免疫检查点抑制剂相关皮肤毒性预防及护理的最佳证据,为临床医护人员提供参考。方法采用乔安娜布里格斯研究所循证卫生保健中心的PIPOST模型构建循证护理问题,根据"6S"金字塔模型自上而下检索国内外数据库、专业协会网站、指南网等,获取关于肺癌患者免疫检查点抑制剂(ICIs)相关皮肤毒性预防与护理的指南、专家共识、系统评价、最佳实践、证据总结及原始研究,筛选符合纳入标准的文献,对文献进行质量评价,并提取证据。检索时限均为建库至2022年10月1日。结果共纳入14篇文献,其中专家共识6篇,指南5篇,系统评价3篇。从高危因素、基线筛查、ICIs治疗期间监测、日常皮肤护理、多学科管理、症状处理、健康教育7个方面共汇总24条最佳证据。结论医护人员应结合临床情境,考虑患者的需求和偏好,采用最佳证据制订科学的、个性化的护理方案,以降低ICIs相关皮肤毒性的发生。

Objective To summarize the best evidence for the prevention and nursing of immune checkpoint inhibitor(ICI)associated skin toxicity in lung cancer patients,providing reference for clinical and nursing staff.Methods Evidence-based nursing issues were constructed using the population,intervention,professional,outcome,setting and type of evidence(PIPOST)model of the Joanna Briggs Institute Evidence Based Health Care Center.The"6S"pyramid model was used to search for guidelines,expert consensus,systematic reviews,best practices,evidence summary,and original research on the prevention and nursing of ICI associated skin toxicity in lung cancer patients from top to bottom in domestic and foreign databases,professional association websites,and guideline websites.Articles that met the inclusion criteria was screened,evaluated for quality,and evidence was extracted.The search period was from the establishment of the database to October 1,2022.Results A total of 14 articles were included,involving 6 expert consensuses,5 guidelines,and 3 systematic reviews.A total of 24 best evidences were summarized from 7 aspects,including high-risk factors,baseline screening,immune checkpoint inhibitors(ICIs)treatment monitoring,daily skin nursing,multidisciplinary management,symptom management,and health education.Conclusions Medical and nursing staff should combine clinical situations,consider the needs and preferences of patients,and use the best evidence to develop scientific and personalized nursing plans to reduce the occurrence of ICI associated skin toxicity.