维持性血液透析患者焦虑及抑郁非药物干预最佳证据总结

Summary of best evidence for non-pharmacological interventions for anxiety and depression in patients receiving maintenance hemodialysis

目的总结维持性血液透析患者焦虑及抑郁非药物干预的最佳证据。方法按照"6S"证据资源金字塔模型,从上至下逐层检索BMJ Best Practice、UpToDate、国际指南网、英国国家卫生与临床优化研究所、国际肾脏病学会网站、医脉通、Cochrane Library、PubMed、Web of Science、中国知网、中国生物医学文献数据库等数据库和网站中关于维持性血液透析患者焦虑及抑郁非药物干预的证据,包括指南、专家共识、最佳实践信息册、系统评价、Meta分析等。检索时限为2013年9月1日—2023年9月1日,由2名研究人员进行文献质量评价、提取证据,结合证据评价小组意见进行证据汇总及推荐。结果共纳入18篇文献,其中指南1篇、专家共识2篇、临床决策1篇、证据总结1篇、系统评价13篇。从筛查与评估、运动干预、改善生活方式、心理干预、其他方式干预、人员与信息支持6个方面汇总了22条最佳证据。结论基于循证的维持性血液透析患者焦虑及抑郁状态的非药物干预手段多样,证据应用时应遵循个体化原则,证据之间联合应用效果更佳。

Objective To summarize the best evidence for non-pharmacological interventions for anxiety and depression in patients receiving maintenance hemodialysis(MHD).Methods According to the"6S"evidence hierarchy model,evidence on non-pharmacological interventions for anxiety and depression in patients receiving MHD was systematically searched from top to bottom across databases and websites,including BMJ Best Practice,UpToDate,International Guideline Network,National Institute for Health and Care Excellence(NICE),International Society of Nephrology,Medlive,Cochrane Library,PubMed,Web of Science,China National Knowledge Infrastructure,and China Biology Medicine disc.The search timeframe was from September 1,2013,to September 1,2023.Two researchers independently evaluated the quality of the literature,extracted evidence,and summarized recommendations in collaboration with an evidence evaluation group.Results A total of 18 articles were included,comprising one guideline,two expert consensuses,one clinical decision,one evidence summary,and 13 systematic reviews.A total of 22 best evidence points were summarized in six aspects:screening and assessment,exercise interventions,lifestyle improvements,psychological interventions,other forms of interventions,and personnel and information support.Conclusions Evidence-based non-pharmacological interventions for anxiety and depression in patients receiving MHD are diverse.The application of evidence should adhere to the principle of individualization,and the combined use of different evidence-based interventions may yield better outcomes.