脊髓损伤神经源性肠道功能障碍相关指南的质量评价及内容分析

Quality evaluation and content analysis of nursing guidelines for neurogenic bowel dysfunction after spinal cord injury

目的对国内外脊髓损伤神经源性肠道功能障碍相关指南进行质量评价和内容分析,为临床开展以证据为基础的脊髓损伤神经源性肠道功能障碍护理实践提供参考。方法系统检索BMJ Best Practice、国际指南协作网、美国国立指南文库、英国国家临床医学研究所、苏格兰校际指南网、安大略省注册护士协会、美国脊髓损伤学会、美国残疾退伍军人协会、医脉通临床指南库、PubMed、Web of Science、CINAHL、Cochrane Library、Ovid数据库、万方、中国知网、中华医学期刊全文数据库中的相关指南,采用AGREEⅡ对纳入的循证指南进行质量评价,采用JBI的专家共识评价标准对专家共识类指南进行质量评价,运用内容分析法整合指南的推荐意见。结果最终纳入10篇文献,其中6篇循证指南,4篇专家共识类指南。3篇循证指南的质量评价结果为A级,3篇结果为B级。10篇指南内容分析汇总为分类、护理目标、评估、基础肠道护理、药物护理、肠道灌洗、电和磁刺激、并发症预防、健康教育和护理记录10个主题27条推荐意见。结论本研究整合了脊髓损伤神经源性肠道功能障碍相关指南中护理相关内容,总结10个主题,内容丰富,整体质量较高,部分争议内容有待进一步研究。国内脊髓损伤神经源性肠道功能障碍护理指南欠缺,需组建多学科小组构建符合国内临床情境的护理指南。

Objective To evaluate the quality of nursing guidelines for neurogenic bowel dysfunction(NBD)after spinal cord injury(SCI)and to provide reference for evidence-based nursing practice of NBD after SCI.Methods We conducted a systematic search of relevant guidelines in BMJ Best Practice,Guidelines International Network,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Scottish Intercollegiate Guidelines Network,The Registered Nurses'Association of Ontario,American Spinal Injury Association,Disabled American Veterans,Medlive Guideline,PubMed,Web of Science,CINAHL,Cochrane Library,Ovid databases,Wanfang Data,CNKI,and Chinese Medical Journal Full-text Database.The quality assessment of the included evidence-based guidelines was performed using the AGREE II tool,while that of the expert consensus guidelines using the JBI consensus evaluation criteria.The recommendations from the guidelines were synthesized using content analysis.Results A total of 10 articles were included,including 6 evidence-based guidelines and 4 expert consensus guidelines.Among the evidence-based guidelines,3 were rated as Grade A,and 3 as Grade B.The content analysis of the 10 guidelines resulted in 27 recommendations across 10 themes,including classification,nursing goals,assessment,basic bowel care,medication nursing,bowel irrigation,electrical and magnetic stimulation,prevention of complications,health education,and nursing documentation.Conclusion This study summarizes nursing-related content in guidelines for NBD after SCI.The overall quality of the included guidelines is relatively high,and the study identifies 10 themes with in-depth content.However,there are some controversial topics requiring further research.There is a lack of nursing guidelines for NBD after SCI in China,and it is necessary to establish multidisciplinary teams to develop nursing guidelines that are suitable for domestic nursing practice.