血液透析患者自体动静脉内瘘血栓预防的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.13.016

摘要/Abstract

摘要：

目的检索、评价并汇总血液透析患者动静脉内瘘血栓预防的最佳证据,为提高自体动静脉内瘘长期生存率提供参考。方法根据循证护理方法,系统检索BMJ最佳临床实践、UpToDate临床顾问、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、Cochrane图书馆、DynaMed循证知识库、美国指南网等指南数据库、美国国家肾脏基金会等专业协会网站、PubMed等综合数据库中有关血液透析患者自体动静脉内瘘血栓预防的证据,文献类型包括临床决策、临床指南、证据总结、系统评价、专家共识。由循证团队进行证据的提取、汇总、质量评价。结果通过文献检索共纳入文献14篇,其中临床决策5篇,指南6篇,系统评价1篇,专家共识2篇。结合临床专业人员意见汇总6个主题、34条证据,包括评估、监测与筛查、自体动静脉内瘘的规范使用、人员与培训、健康教育、透析低血压管理。结论该研究总结了自体动静脉内瘘血栓预防的最佳证据,可为透析中心医护人员提供参考。临床医护人员采纳证据应用到临床时要结合专业人员判断及患者偏好,审慎应用。

关键词: 血液透析, 自体动静脉内瘘, 血栓预防, 循证护理学

Abstract:

Objective To search,evaluate and summarize the best evidence for thrombosis prevention of arteriovenous fistula（AVF） in hemodialysis patients,and to provide references for improving the long-term survival rate of autologous AVF. Methods According to the guidance of evidence-based nursing methods,we searched BMJ Best Clinical Practice,UpToDate,JBI Library,Cochrane Library,DynaMed,Agency for Healthcare Research and Quality and other guideline databases,National Kidney Foundation and other professional associations,PubMed and other comprehensive databases for the related studies on the prevention of autologous AVF thrombosis in hemodialysis patients. The evidence-based team extracted,summarized and evaluated the evidence. Results A total of 14 pieces of the literature were included through literature search,including 5 clinical decisions,6 guidelines,2 expert consensuses,and 1 systematic evaluation. Totally 34 pieces of evidence were selected,including assessment,monitoring and screening,standardized use of AVF,personnel qualification and training,health education,and intradialytic hypotension management,based on evidence-based evidence extraction and opinions of clinical professionals. Conclusion This study summarizes the best evidence for AVF thrombosis prevention and provides a reference for medical staff in dialysis centers. Through the clinical application of evidence,we can make the monitoring and maintenance of autologous arteriovenous fistula work better,and the quality of nursing care can be improved.

Key words: Hemodialysis, Autogenous Arteriovenous Fistula, Thrombosis Prevention, Evidence-Based Nursing

申鹏, 李宏, 郭珏, 王爱萍, 乔金红. 血液透析患者自体动静脉内瘘血栓预防的最佳证据总结[J]. 中华护理杂志, 2022, 57(13): 1634-1640.

SHEN Peng, LI Hong, GUO Jue, WANG Aiping, QIAO Jinhong. Evidence summary for thrombosis prevention of autogenous arteriovenous fistula in maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2022, 57(13): 1634-1640.

图/表 4

图1 文献筛选流程图注：JBI为澳大利亚乔安娜布里格斯研究所循证卫生保健中心,AHRQ为美国指南网,NICE为英国国家卫生与临床优化研究所,RNAO为加南大安大略护理学会网站,SIGN为苏格兰校际指南网,GIN为全球指南协作网,CKN为护理实践指南网站,ESVS为欧洲血管外科学会,NKF为美国国家肾脏基金会。

Figure 1 Flow chart of literature screening

表1 纳入文献的基本特征（n=14）

Table 1 General information of the included literature（n=14）

表2 指南的质量评价结果（n=6）

Table 2 Quality evaluation results of the guidelines（n=6）

表3 血液透析患者AVF血栓预防的最佳证据总结

Table 3 Summary of the best evidence for AVF thrombosis prevention in hemodialysis patients

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