经股动脉穿刺脑血管介入治疗围手术期术肢管理的最佳证据

Best evidence for the management of perioperative limb after transfemoral arterial puncture for cerebrovascular intervention treatment

目的:经股动脉穿刺脑血管介入治疗围手术期术肢管理尚未形成整体、全面的循证管理方案。本研究通过系统的证据提取及汇总,以期形成完整的经股动脉穿刺脑血管介入治疗围手术期术肢管理策略,为降低患者并发症,改善患者预后提供循证依据。方法:通过PIPOST(population,intervention,professional,outcome,setting,type of evidence)方法构建股动脉穿刺脑血管介入治疗围手术期术肢管理内容的临床循证问题后,检索各大数据库以及专业网站的相关文献,并由2名研究者对纳入的文献进行质量评价后,对证据进行提取和汇总。结果:共纳入17篇文献,包括指南3篇、临床决策2篇、专家共识2篇、系统评价3篇、证据总结3篇、随机对照试验4篇。共总结出23条证据,包括术前准备、术中观察与配合、术后评估、术后止血、术后活动时机与方式、术后并发症的预防与管理,涵盖了术前、术中及术后术肢管理的相关内容。结论:本研究总结的证据为构建经股动脉穿刺脑血管介入治疗围手术期术肢管理方案提供了新思路,但将最佳证据转化引入临床时,护理人员应结合患者的临床特点,引入适用于临床的证据。

Objective:A comprehensive and evidence-based management strategy for perioperative limb management after transfemoral arterial puncture for cerebrovascular intervention treatment has not been established.This study aims to formulate a complete strategy for the perioperative limb management through systematic evidence extraction and summarization and to provide evidence-based recommendations for reducing complications and improving patient prognosis.Methods:Using the PIPOST(population,intervention,professional,outcome,setting,type of evidence)method,clinical evidence questions related to the content of perioperative limb management after arterial puncture for cerebrovascular intervention treatment were constructed.Relevant literature was searched in the major databases and professional websites.After quality assessment by 2 researchers,the evidence was extracted and summarized.Results:A total of 17 articles were included,comprising 3 guidelines,2 clinical decisionmaking articles,2 expert consensus,3 systematic reviews,3 evidence summaries,and 4 randomized controlled trials.A total of 23 pieces of evidence were identified,covering aspects such as preoperative preparation,intraoperative observation and cooperation,postoperative assessment,postoperative hemostasis,timing and methods of postoperative activity,and prevention and management of postoperative complications.The contents addressed preoperative limb management before,during,and after the procedure.Conclusion:The evidence summarized in this study provides a new perspective for constructing a perioperative limb management strategy after transfemoral arterial puncture for cerebrovascular intervention treatment.However,when translating the best evidence into clinical practice,healthcare professionals should consider the clinical characteristics of individual patients and incorporate evidence that is applicable to their specific clinical situations.