下肢静脉溃疡周围皮肤护理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2024.10.12.006

摘要/Abstract

摘要：

目的总结下肢静脉溃疡周围皮肤护理的相关证据，为医护人员及患者护理皮肤提供参考。方法按照“6S”金字塔模型，检索UpToDate、BMJ Best Practice、国际指南协作网、医脉通、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 Library、PubMed、中国知网、万方数据库、爱尔兰国家医疗服务中心网站、美国伤口造口失禁护士协会网站、欧洲血管外科学会网站、伤口发展协会网站、伤口愈合协会网站、新西兰伤口护理协会网站中所有与下肢静脉溃疡周围皮肤护理有关的文献，包括临床决策、指南、最佳实践、专家共识、证据总结、系统评价、随机对照试验。检索时限为建库至2023年10月11日。由2名护理硕士研究生对纳入文献进行质量评价，结合循证护理专家和伤口护理专家的意见，提取、汇总证据。结果共纳入13篇文献，其中，临床决策1篇、证据总结1篇、指南6篇、最佳实践1篇、系统评价1篇、随机对照试验3篇。形成包括皮肤治疗、皮肤清洁、皮肤保湿、渗液管理以及压力治疗5个证据主题的24条最佳证据。结论该研究总结的下肢静脉溃疡周围皮肤护理的最佳证据较为科学、全面，可为临床转化提供资源准备，为医护人员及患者进行溃疡周围皮肤护理提供指导。

关键词: 下肢静脉溃疡, 伤口周围皮肤, 循证护理学, 证据总结

Abstract:

Objective To summarize the relevant evidence of skin management around venous leg ulcers，and to provide a reference for medical staff and patients to manage the skin. Methods According to the 6S model，we searched UpToDate，BMJ Best Practice，Guidelines International Network，Medlive，Joanna Briggs Institute，Cochrane Library，PubMed，CNKI，Wanfang data，Health Service Executive，Wound，Ostomy，and Continence Nurses Society，European Society for Vascular Surgery，Association for the Advancement of Wound Care，Wound Healing Society，New Zealand Wound Care Society for all the articles related to skin management around venous leg ulcers. The retrieved literature included clinical decision-making，guidelines，best practices，expert consensuses，evidence summaries，systematic reviews，and randomized controlled trials. The retrieval period was from the inception of databases to October 11，2023. There were 2 nursing postgraduate who evaluated the quality of the included literature，and the evidence was extracted and summarized combined with the opinions of evidence-based nursing experts and wound care specialists. Results A total of 13 articles were included，including 1 clinical decision，1 evidence summary，6 guidelines，1 best practice，1 systematic review，and 3 RCTs. Finally，5 evidence themes and 24 pieces of best evidence were formed including skin therapy，skin cleaning，skin moisturizing，exudation management，and pressure therapy. Conclusion This study summarized the best evidence for the treatment，nursing，exudation management，and pressure therapy of the skin around the ulcer in patients with venous leg ulcers，to provide resource preparation for clinical transformation and guidance for clinical medical care and patient management of the skin around the ulcer.

Key words: Venous Leg Ulcers, Surrounding Skin, Evidence-Based Nursing, Evidence Summary

仲宇, 魏惠燕, 林淑洁, 汤磊雯. 下肢静脉溃疡周围皮肤护理的最佳证据总结[J]. 中华护理杂志, 2024, 59(12): 1446-1453.

ZHONG Yu, WEI Huiyan, LIN Shujie, TANG Leiwen. Summary of the best evidence for surrounding skin management in venous leg ulcers[J]. Chinese Journal of Nursing, 2024, 59(12): 1446-1453.

图/表 4

图1 文献筛选流程图注：JBI为乔安娜布里格斯研究所；HSE为爱尔兰国家医疗服务中心；WOCN为美国伤口造口失禁护士协会；ESVS为欧洲血管外科医师协会；AAWC为伤口发展协会；WHS为伤口愈合协会；NZWCS为新西兰伤口护理学会。

Figure 1 Flow chart of literature

表1 纳入文献的基本特征（n=13）

Table 1 Characteristics of included literature（n=13）

表2 纳入指南与最佳实践的方法学质量评价结果（n=6）

Table 2 Quality evaluation results of guidelines and best practice（n=6）

表3 下肢静脉溃疡周围皮肤护理的最佳证据总结

Table 3 Summary of the best evidence for surrounding skin management in venous leg ulcers

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