ICU脑损伤患者目标体温管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.21.014

摘要/Abstract

摘要： 目的检索、评价和总结ICU脑损伤患者目标体温管理的相关证据，为临床提供参考。方法根据6S证据模型，计算机检索BMJ Best Practice、UpToDate、全球各指南网站、Cochrane Library、Embase等循证医学数据库，PubMed、中国知网等中英文相关数据库及专业学会网站的相关文献，文献类型包括指南、临床决策、专家共识、证据总结、系统评价等，检索时限为2012年1月—2023年4月，由接受循证培训的研究者进行文献评价后提取证据。结果共纳入19篇文献，指南6篇，临床决策3篇，专家共识5篇，系统评价4篇，证据总结1篇。分别从温度范围、启动时机、体温监测、管路建立、镇痛镇静管理、机械通气与氧合管理、血流动力学支持、营养支持、病情监测和神经功能预后评估10个方面汇总了25条最佳证据。结论该研究总结的脑损伤患者在ICU内目标体温管理的最佳证据具有一定的临床实用性及科学性，可规范医护人员的实践，保障重症患者的安全。

关键词: 重症监护病房, 脑损伤患者, 目标体温管理, 证据总结

Abstract:

Objective To evaluate and summarize the evidence related to targeted temperature management in brain injury patients with ICU for health care workers and decision makers. Methods We systematically searched from the guideline websites，domestic and foreign databases and association official websites to collect the literature including guidelines，expert consensuses，clinic decision-making，evidence summaries and systematic reviews，according to the 6s evidence model. The search time limit was from January 2012 to April，2023. Evidence was extracted after the quality evaluation of the literature was conducted by evidence-based researchers. Results A total of 19 articles were incorporated，including 6 guidelines，3 clinic decision-making，5 expert consensuses，4 systematic reviews and 1 evidence summary. Finally，25 pieces of best evidence were formed from 10 aspects，temperature range，starting time，body temperature monitoring，pipeline management，analgesia and sedation management，mechanical ventilation and oxygenation management，hemodynamic support，nutrition management，condition monitoring and prognosis evaluation. Conclusion The best evidence for management of targeted temperature in brain injury patients with ICU in this study is scientific and comprehensive，providing the evidence-based basis for medical staff to standardized management of targeted temperature in critically ill patients in clinical practice.

Key words: Intensive Care Units, Brain Injury Patients, Targeted Temperature Management, Evidence Summary

盖恬恬, 李紫梦, 崔钰, 侯若楠, 许露丹, 何茵. ICU脑损伤患者目标体温管理的最佳证据总结[J]. 中华护理杂志, 2023, 58(21): 2653-2661.

GAI Tiantian, LI Zimeng, CUI Yu, HOU Ruonan, XU Ludan, HE Yin. Evidence summary for targeted temperature management in brain injury patients with ICU[J]. Chinese Journal of Nursing, 2023, 58(21): 2653-2661.

图/表 4

图1 文献筛选流程图

Figure 1 Flow chart of literature screening

表1 纳入文献的基本特征（n=19）

Table 1 Basic characteristics of the included literature（n=19）

表2 纳入指南的质量评价结果（n=6）

Table 2 Quality evaluatio. Results of guidelines（n=6）

表3 ICU脑损伤患者目标体温管理的最佳证据总结

Table 3 Summary of best evidence for targeted temperature management in ICU patients with brain injury

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