预防静脉-动脉体外膜肺氧合患者相关下肢缺血并发症的证据总结

Summary of the evidence for the prevention of lower limb ischemic complications associated with venous-arterial extracorporeal membrane oxygenation patients

目的检索、评价和整合预防静脉-动脉体外膜肺氧合(VA-ECMO)患者相关下肢缺血并发症的相关证据,为制订科学完整的下肢缺血并发症预防及管理方案提供参考。方法采用循证方法学,检索中国知网、万方数据库、PubMed、Cochrane Library等国内外数据库以及相关专业网站中关于VA-ECMO患者相关下肢缺血并发症的临床决策、指南、专家共识、证据总结、系统评价、随机对照试验和类实验研究,文献检索时限为建库至2023年8月,由2名研究者独立进行文献质量评价后,根据主题对证据进行提取与汇总。结果初步检索共获得文章27004篇,经筛选后最终纳入11篇文献,包括1篇指南、2篇专家共识、2篇系统评价、6篇原始研究。通过文献阅读、证据提取归类和专家小组会议,共总结出24条最佳证据,包括团队培训及管理、VA-ECMO上机前评估、VA-ECMO置管的选择、下肢缺血的监护管理4个方面。结论该研究总结了预防VA-ECMO患者相关下肢缺血并发症的最佳证据,可为医护人员开展临床实践提供参考。医护人员应结合临床情境、患者意愿,审慎地选择并应用证据,从而保障VA-ECMO治疗安全,降低相关并发症的发生率。

Objective To retrieve,evaluate and integrate the relevant evidence of prevention of lower limb ischemic complications in venous-arterial extracorporeal membrane oxygenation(VA-ECMO)patients,and provide reference for the development of scientific and complete prevention and management of lower limb ischemic complications.Methods According to the evidence-based methodology,clinical decisions,guidelines,expert consensus,evidence summary,systematic review,randomized controlled trials and experimental studies related to lower limb ischemia complications in VA-ECMO patients were searched from CNKI,Wanfang,PubMed,Cochrane Library and other domestic and foreign databases as well as relevant professional websites.The literature search period was from the establishment of the database to August 2023.Two researchers independently evaluated the literature quality,and then extracted and summarized the evidence according to the theme.Results A total of 27004 articles were obtained in the preliminary search,and 11 articles were finally included after screening,including 1 guide,2 expert consensus,2 systematic reviews and 6 original studies.Through literature reading,evidence extraction and classification,and expert group meetings,a total of 24 best evidences were concluded in four dimensions,including team training and management,VA-ECMO pre-computer evaluation,VA-ECMO catheter selection,and the monitoring and management of lower limb ischemia.Conclusions This study summarized the best evidence for the prevention of lower limb ischemia complications associated with VA-ECMO patients,and can provide reference for healthcare providers in clinical practice.In order to ensure the safety of VA-ECMO treatment and reduce the incidence of related complications,healthcare professionals should carefully select and apply evidence according to the clinical context and patients'wishes.