糖尿病患者围手术期血糖管理的证据总结

doi:10.3761/j.issn.0254-1769.2021.07.021

摘要/Abstract

摘要：

目的收集国内外糖尿病患者围手术期血糖管理的证据,并对最佳证据进行总结。方法 2019年11月,系统检索美国国立指南库、苏格兰校际指南网、加拿大安大略注册护理协会网站、英国国家卫生与临床优化研究所网站、乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）网站、Cochrane Library、PubMed、Web of Science、国际糖尿病联盟网站、美国糖尿病协会网站、加拿大糖尿病协会网站、澳大利亚糖尿病协会网站、维普、中国知网、万方数据库和中国生物医学文献数据库等数据库和网站,纳入关于糖尿病患者围手术期血糖管理的证据,包括指南、系统评价、最佳实践信息册、证据总结、专家共识等。检索时限为建库至2019年11月29日。由6名研究者对文献质量进行独立评价,结合专业人士的判断,对符合标准的文献进行资料提取。结果共纳入9篇文献,其中指南6篇、专家共识2篇、系统评价1篇。最佳证据包括血糖管理原则、血糖监测频次、血糖控制目标、控糖用药管理4个类别,共33条证据。结论证据应用人员需结合医院特点和临床实践,有针对性地选择最佳证据,以减少糖尿病患者血糖异常事件、降低术后切口感染、加速术后切口愈合时间。

关键词: 糖尿病, 血糖管理, 围手术期, 循证护理

Abstract:

Objective To collect and summarize the best evidence of perioperative blood glucose management in patients with diabetes at home and abroad. Methods We systematically searched the National Guideline Clearing-house in the United States,Scottish Intercollegiate Guidelines Network,Registered Nurses’ Association of Ontario,Canada,National Institute of Health and Care Excellence in the United Kingdom,Joanna Briggs Institute,Cochrane Library,PubMed,Web of Science,the International Diabetes Federation and American Diabetes Association,Canadian Diabetes Association,Australian Diabetes Association,CNKI,CBM and Wanfang database to collect the literature including guidelines,systematic reviews,best practice information sheets,evidence summaries,expert consensuses,etc. The retrieval period was from the inception of databases to November 29,2019. 6 researchers independently evaluated the quality of the literature,combining with the judgment of professionals,to extract the data from the literature meeting the standards. Results A total of 9 articles were incorporated,including 6 guidelines,2 expert consensuses and 1 systematic review. The best evidence included 33 pieces of evidence in 4 categories,namely glycemic management principles,glycemic monitoring frequency,glycemic control objectives and drug management of glucose control. Conclusion The best evidence should be selected based on the characteristics of the hospital and the clinical environment,to reduce abnormal blood glucose events,reduce postoperative wound infections,and accelerate postoperative wound healing time in patients with diabetes.

Key words: Diabetes Mellitus, Blood Glucose Management, Perioperative Period, Evidence-Based Nursing

倪叶彬,陈亚梅,朱晓萍,王璐,王静,张琳,陈淑娟,林梦月,朱政,周英凤,邢唯杰. 糖尿病患者围手术期血糖管理的证据总结[J]. 中华护理杂志, 2021, 56(7): 1079-1085.

NI Yebin,CHEN Yamei,ZHU Xiaoping,WANG Lu,WANG Jing,ZHANG Lin,CHEN Shujuan,LIN Mengyue,ZHU Zheng,ZHOU Yingfeng,XING Weijie. Evidence summary for management of perioperative blood glucose in patients with diabetes mellitus[J]. Chinese Journal of Nursing, 2021, 56(7): 1079-1085.

图/表 4

表1 纳入文献的一般情况

Table 1 GeneraI characteristics included in the literature

表2 指南的质量评价结果

Table 2 Results of quality evaluation of the guidelines

表3 专家共识的质量评价结果

Table 3 Results of quality evaluation of the expert consensus

表4 糖尿病患者围手术期血糖管理最佳证据总结

Table 4 Best evidence summary for management of perioperative blood glucose in patients with diabetes mellitus

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