胰十二指肠切除术后出血风险评估的最佳证据

Best evidence for assessing the risk of postpancreatoduodenectomy hemorrhage

目的总结胰十二指肠切除术后患者发生出血风险评估的最佳证据。方法运用循证护理理论,依据循证检索资源的"6S"原则,计算机检索PubMed、OVID-JBI、Cochrane Library、EMbase、SIGN、NGC、NICE、NCCN、ERAS、ISGP、ESA、中国生物医学文献数据库、万方数据库、中国知网、维普数据库中关于胰十二指肠切除患者术后出血风险评估的所有证据,检索时限为建库至2023年9月。运用JBI循证卫生保健中心的文献质量评价工具及证据预分级系统,对纳入文献进行质量评价和证据等级评定,运用FAME结构对证据的可行性、适宜性、临床意义和有效性进行评价。结果最终纳入16篇文献,其中9篇系统评价,2篇专家共识,4篇指南,1篇最佳实践建议。归纳出包含术前、术中和术后因素3个方面的22条胰十二指肠切除术患者出血风险评估的证据。结论运用循证护理理论制定了胰十二指肠切除术后出血风险评估的最佳证据,有利于早期甄别胰十二指肠切除术后出血的高危人群。

Objective To obtain the best evidence for assessing the risk of bleeding after pancreatoduodenectomy.Methods Based on the theory of evidence-based nursing,PubMed,OVID-JBI,Cochrane Library,EMbase,SIGN,NGC,NICE,NCCN,ERAS,ISGP,ESA,China Biomedical Literature Database,Wanfang Database,CNKI,VIP database were searched for the relevant evidence of evaluating bleeding risk in patients with pancreatoduodenectomy following the"6S"evidence pyramid order since the databases were established until September 2023.The quality of the articles were evaluated and the evidence was categorized by using quality evaluation tool and evidence pre-grading system of JBI evidence-based health center.FAME structure was used for assessing the feasibility,suitability,clinical significance and efficacy of the evidence.Results Finally,16 articles were included,including 9 systematic reviews,2 expert consensus,4 guidelines,and 1 best practice recommendation.This paper summarized 22 pieces of evidence for the risk assessment of bleeding in patients undergoing pancreatoduodenectomy,including 3 aspects before,during and after surgery.Conlusions The best evidence for the risk assessment of postpancreatoduodenectomy bleeding is developed by using evidence-based nursing theory,which is conducive to identify the high-risk group for postpancreatoduodenectomy bleeding at early stage.