中医护理技术在慢性肾脏病症状管理中应用的证据总结

Summary of evidence on the application of traditional Chinese medicine nursing techniques in the management of chronic kidney disease symptoms

目的:系统检索总结中医护理技术在慢性肾脏病症状管理中应用的最佳证据。方法:使用PIPOST模式确定循证问题,按照证据金字塔“6S”证据模型自上而下检索BMJ最佳临床实践、UpToDate、国际指南协作网、中国知网等国内外数据库中关于中医护理技术在慢性肾脏病症状管理的临床决策、推荐实践、最佳临床实践信息册、证据总结、指南、系统评价、专家共识、随机对照试验。由2名研究者独立对文献质量进行评价并提取相关资料,对符合纳入标准的文献进行证据总结。检索时限从2012年1月1日-2022年10月31日。结果:共纳入文献15篇,包括1篇专家共识、6篇系统评价和Meta分析、1篇证据总结、1篇系统综述和6篇随机对照试验研究。总结了8项中医护理技术(耳穴贴压、穴位按摩、灸法、敷药法、药浴法、熏洗法、中药灌肠、刮痧)在慢性肾脏病常见14种症状(睡眠障碍、皮肤瘙痒、高血压、便秘、疼痛、抑郁、蛋白尿、疲乏、肌肉痉挛、不宁腿综合征、功能活动障碍、水肿、透析中低血压、恶心呕吐)中应用的26条证据。结论:总结的最佳证据为临床中医护理技术在慢性肾脏病症状管理的应用提供了循证依据,但在证据转化时应结合具体的情境和病人意愿,提高慢性肾脏病症状管理水平。

Objective:To systematically retrieve and summarize the best evidence on applying traditional Chinese medicine(TCM)nursing techniques in managing chronic kidney disease(CKD)symptoms.Methods:The PIPOST model was used to identify evidence-based issues and search from top to bottom following the evidence pyramid"6S"evidence model.Relevant clinical decision-making,recommended practice,best clinical practice information booklet,evidence summary,guidelines,systematic reviews,expert consensus,and randomized controlled trials(RCT)on TCM nursing technology applied in the management of kidney disease symptoms were retrieved from BMJ Best Clinical Practice,UpToDate,International Guideline Collaboration Network,CNKI,and other databases in China and abroad.Two researchers independently evaluated the quality of the literature,extracted relevant data,and summarized the evidence for the literature that met the inclusion criteria.The search time limit was from January 1,2012,to October 31,2022.Results:A total of 15 articles were included in this study,including 1 expert consensus article,6 systematic reviews and Meta-analyses,1 evidence summary,1 systematic review,and 6 RCT studies.A total of 26 pieces of evidence were summarized from 8 TCM nursing techniques(auricular pressure,acupoint massage,moxibustion,dressing,medicated bath,fumigation,traditional Chinese medicine enema,scraping)applied in 14 common symptoms(sleep disorder,skin itching,hypertension,constipation,pain,depression,proteinuria,fatigue,muscle cramps,restless legs syndrome,functional mobility impairment,edema,intradialytic hypotension,nausea and vomiting)of CKD.Conclusions:The best evidence summarized provided an evidence-based basis for applying clinical TCM nursing technology in managing CKD symptoms.However,the specific situation and patients′wishes should be combined when transforming evidence to improve CKD symptom management.