预防成人术中获得性压力性损伤的最佳证据总结

doi:10.3761/j.issn.0254-1769.2020.10.022

摘要/Abstract

摘要：

目的检索、评价并整合国内外预防成人术中获得性压力性损伤的相关证据,并对最佳证据进行总结。方法检索加拿大安大略注册护士协会、英国国家卫生与临床优化研究所、苏格兰学院间指南网、美国指南网、国际指南网、医脉通、British Medical Journal最佳临床实践、UpToDate、Cochrane Library、乔安娜布里格斯研究所（Joanna Briggs Institute,JBI） Library、PubMed、CINAHL、荷兰医学文摘数据库、中国知网、万方数据库、美国压力性损伤咨询小组官网、美国伤口造口失禁护理协会、美国围手术期注册护士协会等网站的相关指南、系统评价和专家共识。检索时间为建库至2019年12月。采用澳大利亚JBI循证卫生保健中心的文献评价标准和证据分级系统,对不同类型研究进行文献质量评价及证据级别评定。结果共纳入文献17篇,其中指南4篇,专家共识1篇,系统评价12篇。结合临床专家判断,总结了27条预防成人术中获得性压力性损伤的证据,包括风险评估、皮肤和组织评估、体位管理、患者交接、体温管理及教育和培训等。结论应结合证据形成多科室联合和多学科合作的预防方案。在证据转化时,结合医院特点和临床环境,有针对性地选择最佳证据,规范患者管理,以降低术中获得性压力性损伤的发生率。

关键词: 手术室, 围手术期护理, 压力性损伤, 循证护理学

Abstract:

Objective To collect,evaluate and integrate the available evidence of prevention of intraoperative acquired pressure injury,and summarize the best evidence. Methods Registered Nurses’ Association of Ontario,National Institute for Health and Clinical Excellence,Scottish Intercollegiate Guidelines Network,National Guideline Clearinghouse,Guidelines International Network,Medlive.cn,British Medical Journal Best Practice,UpToDate,Cochrane Library,Joanna Briggs Institute Library,PubMed,CINAHL,Embase,CNKI,WanFang Data,National Pressure Injury Advisory Panel,Wound Ostomy and Continence Nurses Society,the Association of perioperative Registered Nurses were researched to collect literatures including guidelines,systematic reviews and consensuses. The time limit for the retrieval is from the inception of databases until Decemeber 2019. The JBI evidence appraisal and recommendation system was used to evaluate the quality of studies and the level of evidence. Results 17 pieces of literature were retrieved,including 4 guidelines,12 systematic reviews and 1 consensus. Combined with the judgment of clinical experts,totally 27 peices of evidence were summarized,including risk assessment,skin assessment,position management,patient handover,temperature control,education and training,etc. Conclusion The prevention program of multi-section joint and multi-discipline cooperation should be formed according to the evidence. In the application and implementation of evidence,the best evidence should be selected according to the characteristics of the hospital and the clinical environment,and the management of patients should be standardized to reduce the incidence of intraoperative acquired pressure injury.

Key words: Operating Rooms, Perioperative Nursing, Pressure Injury, Evidence-Based Nursing

刘晓黎,王泠,魏彦姝,吴晓舟. 预防成人术中获得性压力性损伤的最佳证据总结[J]. 中华护理杂志, 2020, 55(10): 1564-1570.

LIU Xiaoli,WANG Ling,WEI Yanshu,WU Xiaozhou. Evidence summary of prevention of intraoperative acquired pressure injury in adult patients[J]. Chinese Journal of Nursing, 2020, 55(10): 1564-1570.

图/表 3

表1 纳入文献的基本特征

Table 1 Characteristics of included studies

表2 指南的质量评价结果

Table 2 Quality assessment of guidelines

表3 预防术中获得性压力性损伤的最佳证据总结

Table 3 Summary of the best evidence for the prevention of IAPI in adult patients

参考文献 33

[1]	National Pressure Ulcer Advisory Panel,European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Aliance. Prevention and Treatment of Pressure Ulcers/Injuries：Clinical Practice Guideline[EB/OL]. (2019-10-01)[2019-12-15]. https//npiap.com/page/Guidelines
[2]	成守珍, 郜迎雪, 郭志东, 等. 护士对卧床患者压力性损伤护理知识和态度的调查研究[J]. 中华护理杂志, 2018,53(7):837-840.
	Cheng SZ, Gao YX, Guo ZD, et al. Study on clinical nurses’ knowledge and attitude on pressure ulcer prevention and intervention among bedridden patients[J]. Chin J Nurs, 2018,53(7):837-840.
[3]	Mervis JS, Phillips TJ. Pressure ulcers:Prevention and management[J]. J Am Acad Dermatol, 2019,81(4):893-902. DOI URL PMID
[4]	Grap MJ, Schubert CM, Munro CL, et al. OR time and sacral pressure injuries in critically ill surgical patients[J]. AORN J, 2019,109(2):229-239. DOI URL PMID
[5]	Qaseem A, Mir TP, Starkey M, et al. Risk assessment and prevention of pressure ulcers:a clinical practice guideline from the American College of Physicians[J]. Ann Intern Med, 2015,162(5):359-369. DOI URL PMID
[6]	Wound,Ostomy and Continence Nurses Society-Wound Guidelines Task Force. WOCN 2016 guideline for prevention and management of pressure injuries(ulcers);an executive summary[J]. J Wound Ostomy Continence Nurs, 2017,44(3):241-246. DOI URL PMID
[7]	米元元, 陈婷, 周英凤, 等. 脊柱外科术后患者深静脉血栓预防及管理的最佳证据总结[J]. 中华护理杂志, 2019,54(2):288-294.
	Mi YY, Chen T, Zhou YF, et al. Evidence summary for prevention and management of deep venous thrombosis after spinal surgery[J]. Chin J Nurs, 2019,54(2):288-294.
[8]	Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009,12(4):99-101. DOI URL PMID
[9]	Hoffmann-Eβer W, Siering U, Neugebauer EA, et al. Guideline appraisal with AGREE II:systematic review of the current evi-dence on how users handle the 2 overall assessments[J]. PLoS One, 2017,12(3):e0174831. DOI URL PMID
[10]	Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2:a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions,or both[J]. BMJ, 2017,358:j4008. DOI URL PMID
[11]	The Joanna Briggs Institute（JBI）[EB/OL]. (2017-07-15)[2019-12-15]. http//joannabriggs.org/research/critical-appraisal-tools.html.
[12]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and Evidence Recommendation Level System(2014 edition)[J]. J Nurs Train, 2015,30(11):964-967.
[13]	Registered Nurses’ Association of Ontario. Risk assessment and prevention of pressure ulcers[EB/OL]. (2005-03-15)[2019-12-15]. https://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers.
[14]	Spruce L. Back to basics:preventing perioperative pressure injuries[J]. AORN J, 2017,105(1):92-99. DOI URL PMID
[15]	Bulfone G, Bressan V, Morandini A, et al. Perioperative pressure injuries:a systematic literature review[J]. Adv Skin Wound Care, 2018,31(12):556-564. DOI URL PMID
[16]	姚丽, 丁楠楠, 杨丽平, 等. 不同减压装置预防手术压力性损伤的网状Meta分析[J]. 中国循证医学杂志, 2018,18(10):1086-1092.
	Yao L, Ding NN, Yang LP, et al. Effects of different decompression device in the prevention of pressure sore:a network meta-analysis[J]. Chin J Evid-Based Med, 2018,18(10):1086-1092.
[17]	王欣怡, 宋俐, 王萍, 等. 不同类型敷料对手术压疮预防效果的贝叶斯网状Meta分析[J]. 护士进修杂志, 2018,33(11):963-968.
	Wang XY, Song L, Wang P, et al. Effects of dressings on the prevention of pressure ulcers in operation patients:a Baye-sian network Meta-analysis[J]. J Nurs Train, 2018,33(11):963-968.
[18]	Liang MN, Chen QN, Zhang Y, et al. Impact of diabetes on the risk of bedsore in patients undergoing surgery:an updated quantitative analysis of cohort studies[J]. Oncotarget, 2017,8(9):14516-14524. DOI URL PMID
[19]	Chen HL, Shen WQ, Liu P, et al. Length of surgery and pressure ulcers risk in cardiovascular surgical patients:a dose-response meta-analysis[J]. Int Wound J, 2017,14(5):864-869. DOI URL PMID
[20]	de Oliveira KF, Nascimento KG, Nicolussi AC, et al. Support surfaces in the prevention of pressure ulcers in surgical patients:an integrative review[J]. Int J Nurs Pract, 2017,23(4):e12553-12565. DOI URL
[21]	Shafipour V, Ramezanpour E, Gorji MA, et al. Prevalence of post-operative pressure ulcer:a systematic review and meta-analysis[J]. Electron Physician, 2016,8(11):3170-3176. DOI URL PMID
[22]	Rao AD, Preston AM, Strauss R, et al. Risk factors associated with pressure ulcer formation in critically ill cardiac surgery patients:a systematic review[J]. J Wound Ostomy Continence Nurs, 2016,43(3):242-247. DOI URL PMID
[23]	Kang ZQ, Zhai XJ. The association between pre-existing diabetes mellitus and pressure ulcers in patients following surgery:a meta-analysis[J]. Sci Rep, 2015,5:13007. DOI URL PMID
[24]	Huang HY, Chen HL, Xu XJ. Pressure-redistribution surfaces for prevention of surgery-related pressure ulcers:a meta-analysis[J]. Ostomy Wound Manage, 2013,59(4):36-38. URL PMID
[25]	Liu P, He W, Chen HL. Diabetes mellitus as a risk factor for surgery-related pressure ulcers:a meta-analysis[J]. J Wound Ostomy Continence Nurs, 2012,39(5):495-499. DOI URL PMID
[26]	He W, Liu P, Chen HL. The Braden Scale cannot be used alone for assessing pressure ulcer risk in surgical patients:a meta-analysis[J]. Ostomy Wound Manage, 2012,58(2):34-40. URL PMID
[27]	马红利, 袁晓华, 张文敏, 等. 术中压疮影响因素的Meta分析[J]. 重庆医学, 2016,45(31):4389-4392.
	Ma HL, Yuan XH, Zhang WM, et al. A meta-analysis of influencing factors of intraoperative pressure sores[J]. Chongqing Med, 2016,45(31):4389-4392.
[28]	戴靖华. 手术患者术中压疮发生危险因素的Meta分析[J]. 中国药物与临床, 2017,17(3):443-446.
	Dai JH. A meta-analysis of risk factors of intraoperative pressure sores of surgery patients[J]. Chin Remed & Clin, 2017,17(3):443-446.
[29]	Zha ML, Cai JY, Song YP, et al. Patient-controlled analgesia and postoperative pressure ulcer:a meta-analysis of observational studies[J]. Wounds, 2019,31(1):1-6. URL PMID
[30]	罗彩凤, 贾静, 柏素萍, 等. 围手术期患者压疮评估及评估工具使用现状的调查研究[J]. 中华护理杂志, 2017,52(4):409-413.
	Luo CF, Jia J, Bo SP, et al. Investigation and analysis of pressure ulcer assessment and tool utilization for perioperative patients[J]. Chin J Nurs, 2017,52(4):409-413.
[31]	胡娟娟, 高兴莲, 杨英, 等. 手术室护士和病房护士皮肤合作评估及管理在手术高危压疮患者中的应用[J]. 现代临床护理, 2018,17(3):29-32.
	Hu JJ, Gao XL, Yang Y, et al. Collaborative assessment and management on skin of surgical patients with high-risk pressure ulcer by nurses from operating room and wards[J]. Mod Clin Nurs, 2018,17(3):29-32.
[32]	房师荣. 循环水变温毯联合软聚硅酮泡沫敷料预防体外循环手术中压疮的相关研究[D]. 青岛:青岛大学, 2016.
	Fang SR. Study on the prevention of pressure sores in extracorporeal circulation operation with circulating water warming blanket combined with soft polysilicone foam dressing[D]. Qingdao:Qingdao University, 2016.
[33]	余文静, 肖瑶, 胡娟娟, 等. 预防围手术期患者低体温的最佳证据总结[J]. 中华护理杂志, 2019,54(4):589-594.
	Yu WJ, Xiao Y, Hu JJ, et al. Evidence summary for prevention of perioperative hypothermia in patients[J]. Chin J Nurs, 2019,54(4):589-594.