外科手术患者术中深静脉血栓预防的最佳证据总结

Summary of the best evidence for intraoperative prevention of deep vein thrombosis in surgical patients

目的检索、评价并整合外科手术患者术中深静脉血栓(DVT)预防的最佳证据,为手术室临床护理实践提供参考。方法根据PIPOST模型确立循证护理问题,按照证据的“6S”金字塔模型,自上而下系统检索美国国立指南库、国际指南协作网、苏格兰院际指南网、医脉通、Cochrane Library、JBI循证资源数据库、美国胸科医师协会、美国血液协会、美国围手术期注册护士协会、欧洲麻醉学会、加拿大安大略注册护士协会、英国国家健康和护理卓越研究所、PubMed、Web of Science核心合集数据库、Medline、中国知网、中国生物医学文献数据库、维普网、万方数据知识服务平台等数据库中关于手术室患者术中预防DVT的所有证据,包括临床决策、指南、专家共识、证据总结、系统评价及meta分析,检索时间为2012年1月至2023年12月,对符合标准的文献进行质量评价、证据提取和分级。结果研究共纳入12篇文献,其中包括指南5篇、专家共识4篇、系统评价1篇、证据总结2篇,从多学科团队协作、术前评估、术中麻醉管理、术中基础预防、专科预防、术中机械预防、术中药物预防、监测与交接8个方面,总结、归纳出28条最佳证据。结论外科手术患者术中DVT的预防需要多学科共同协作,证据应用过程中需要结合科室和患者的具体情况,审慎地将证据应用于临床,降低患者术中DVT发生率,提升临床护理质量。

Objective To search,evaluate,and integrate the best evidence of intraoperative deep vein thrombosis(DVT)prevention in surgical patients,and to provide reference for clinical nursing practice in operating room.Methods According to PIPOST model,evidence-based questions were established.According to“6S”pyramid model of evidence,all the evidence about intraoperative prevention of DVT in operating room patients were systematically searched from top to bottom on the US National Guide Library,the International Guide Network,the Scottish Interinstitutional Guide Network,the Medical Mai Tong,the Cochrane Library,JBI Evidence-based Resource Database,American Association of Chest Physicians,American Society of Hematology,American Association of Perioperative Registered Nurses,European Society of Anaesthesia,Ontario Registered Nurses Association,UK National Institute for Health and Care Excellence,PubMed,Web of Science Core Collection Database,Medline,CNKI,China Biomedical Literature Database,VIP,and Wanfang Data,including clinical decision-making,guidelines,expert consensus,evidence summary,systematic review,and meta-analysis,the search period was from January 2012 to December 2023,and the quality evaluation,evidence extraction,and classification of literatures meeting the criteria were carried out.Results A total of 12 articles were included,including 5 guidelines,4 expert consensus,1 systematic review,and 2 evidence summaries.A total of 28 pieces of best evidence were obtainded from 8 aspects,including multidisciplinary team cooperation,preoperative evaluation,intraoperative anesthesia management,intraoperative basic prevention,specialized prevention,intraoperative mechanical prevention,intraoperative drug prevention,and monitoring and handover.Conclusion The prevention of intraoperative DVT in surgical patients requires multi-disciplinary cooperation.In the process of evidence application,the evidence should be carefully applied to the clinic according to the specific conditions of the department and the patient,so as to reduce the incidence of intraoperative DVT and improve the quality of clinical care.