神经重症患者目标体温管理的最佳实践证据总结

Summary of best evidence for targeted body temperature management in patients with severe neurological illness

目的检索、评价及整合神经重症患者目标体温管理的最佳实践证据,为神经重症患者的目标体温管理提供依据。方法采用PIPOST开发工具确定循证问题,以"神经重症"、"颅脑外伤/脑出血/脑中风/脑卒中/蛛网膜下腔出血/脑血管病"、"亚低温治疗/目标体温管理/低温治疗"为中文检索词,以"Traumatic Brain Injuries"、"Craniocerebral trauma/Cerebral hemorrhage/Stroke/Subarachnoid hemorrhage/Cerebral vascular disease"、"Mild hypothermia therapy/Target body temperature/Cryotherapy"英文检索词,依据"6S"证据模型自上而下的原则,检索法国指南网、美国指南网、UpToDate、中国生物医学文献数据库、医脉通、中国知网、万方数据知识服务平台等国内外数据库,由2名研究者独立对纳入的文献进行质量评价,并对符合质量标准的文献进行证据提取和汇总。结果研究共纳入10篇文献,其中临床决策1篇、指南4篇、证据总结1篇、专家共识4篇,最终总结出27条最佳实践证据,包括评估、实施前准备、目标体温的选择、干预时长、寒颤的处理、其他并发症的预防等6个主题。结论最佳实践证据的总结可以为医护人员对神经重症患者实施有效精准的目标体温管理提供更有利的参考依据。

ObjectiveTo retrieve,evaluate,and integrate the best practice evidence for targeted temperature management in neurocritically ill patients.MethodsPIPOST tool was used to identify evidence-based issues;the Chinese and English terms were chosen as"Traumatic brain injuries","Craniocerebral trauma/Cerebral hemorrhage/Stroke/Subarachnoid hemorrhage/Cerebral vascular disease",and"Mild hypothermia therapy/Target body temperature/Cyotherapy".According to top-down design of the"6S"evidence model,databases such as French guideline network,US guideline network,UpToDate,Chinese Biomedical Literature Database,China Yimaitong Guide network,CNKI,and Wanfang Medical Network were searched.Two researchers independently evaluated the quality of the included literature,and extracted and summarized the evidences of the literature that met the quality standards.ResultsA total of 10 articles were included,including 1 clinical decision,4 guidelines,1 evidence summary,and 4 expert consensuses.Finally,27 pieces of best evidences were summarized,including 6 aspects as evaluation,preparation before implementation,targeted body temperature selection,intervention duration,chill management,and other complication prevention.ConclusionBest evidence for temperature management in neurocritically ill patients can provide evidence-based evidence for healthcare professionals.