经皮肾活检患者术后观察时间及卧床时间的最佳证据总结

Summary of best evidence for postoperative observation time and bed rest time in patients undergoing percutaneous renal biopsy

目的检索并总结经皮肾活检患者术后观察时间及卧床时间的相关证据,为经皮肾活检患者的术后护理提供循证依据。方法采用"肾活检""肾穿刺"等检索词,基于"6S"证据资源金字塔模型系统检索国内外各类指南网站、循证数据库、原始研究数据库以及专业协会网站等发布的有关经皮肾活检患者术后观察时间及卧床时间的相关证据,包括指南、最佳实践信息册、证据总结、系统评价、专家共识及原始研究等。检索时限均为建库至2023年7月1日。由2名研究者对纳入的文献独立评价后,对符合质量标准的文献进行证据提取及总结。结果共纳入9篇文献,包括1篇指南、5篇队列研究、3篇横断面研究。从术后观察时间及术后卧床时间2个方面进行汇总,最终形成6条最佳证据。对于经皮肾活检术后并发症发生低风险的患者,推荐术后观察时间为6~8 h,但将观察时间进一步缩短至4~5 h可能也是安全和充分的。对于经皮肾活检术后并发症发生风险最高的患者、住所距离医院较远的患者、独居患者或活检后可能有显著心理应激的患者,建议延长观察时间,可长达24 h。结论基于现有证据,缩短经皮肾活检术后的卧床时间似乎是可行的,但仍需开展更多高质量的研究探讨术后最佳卧床时间。

Objective To retrieve and summarize the evidence for postoperative observation time and bed rest time in patients undergoing percutaneous renal biopsy,so as to provide evidence-based basis for postoperative nursing of patients undergoing percutaneous renal biopsy.Methods Using search terms such as"renal biopsy"and"renal puncture",based on the"6S"evidence resource pyramid model,evidence on postoperative observation time and bed rest time of percutaneous renal biopsy patients,including guidelines,best practice information books,evidence summaries,systematic reviews,expert consensus,and original research,was systematically searched on various guideline websites,evidence-based databases,original research databases,and professional association websites both domestically and internationally.The search period was from database establishment to July 1,2023.After independent evaluation of the included literature by two researchers,evidence was extracted and summarized from the literature that met the quality standards.Results A total of nine articles were included,including one guideline,five cohort studies,and three cross-sectional studies.This study summarized six best pieces of evidence from two aspects,namely postoperative observation time and postoperative bed rest time.For patients with low risk of complications after percutaneous renal biopsy,it was recommended to observe for 6 to 8 hours after surgery,but further shortening the observation time to 4 to 5 hours may also be safe and sufficient.For patients with high risk of complications after percutaneous renal biopsy,those living far from the hospital,those living alone,or those who may experience significant psychological stress after biopsy,it was recommended to extend the observation time to up to 24 hours.Conclusions Based on existing evidence,it seems feasible to shorten the bed rest time after percutaneous renal biopsy.A large amount of high-quality research is still needed to explore the optimal postoperative bed rest time.