中心静脉压测量的最佳证据总结

doi:10.3761/j.issn.0254-1769.2021.10.019

摘要/Abstract

摘要：

目的检索、评价和总结中心静脉压（central venous pressure,CVP）电子测量法相关操作的最佳证据。方法应用循证护理的方法,按照“6S”金字塔模型,进行文献检索,包括CVP电子测量法相关操作的指南、证据总结、专家共识、系统评价、随机对照试验等。检索时限为2005年1月1日—2020年12月31日。由2名研究人员采用临床指南研究与评价系统Ⅱ和澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心对应的评价标准（2016）对文献质量进行独立评价,结合专业人员的判断,对符合标准的文献进行资料提取并依据JBI证据预分级系统（2014版）进行证据分级。结果共纳入28篇文献,包括指南2篇、专家共识4篇、系统评价4篇、随机对照试验13篇、诊断性试验1篇、描述性横断面研究4篇。从通路选择、排除其他干扰因素、患者体位、传感器校零及位置、分析波形及准确读数、设备管理、人员培训7个方面进行证据总结,形成30条最佳证据。结论该研究总结了CVP电子测量法相关操作技术的最佳证据,为提高临床CVP测量的准确性、操作的规范性提供循证依据。

关键词: 中心静脉压, 血流动力学监测, 操作规范, 循证护理学

Abstract:

Objective To search,evaluate and summarize the best evidence of the related operation techniques for electronic measurement of central venous pressure（CVP）. Methods According to the “6S” pyramid model,the computer literature retrieval was carried out by using evidence-based nursing method,including guidelines,recommended practices,evidence summaries,expert consensuses,randomized controlled studies,etc. The search time is from 1 January 2005 to 31 December 2020. 2 researchers independently evaluated the literature quality using the appraisal of guidelines for research and evaluation Ⅱ and the corresponding evaluation standard（2016） of JBI Evidence-based Health Care Center in Australia. Combined with the judgment of professionals,the qualified literature was extracted and graded according to JBI Evidence Pre-grading System（2014 edition）. Results A total of 28 pieces of literature were included,including 2 guidelines,4 expert consensuses,4 systematic reviews,13 randomized controlled studies,1 diagnostic test and 4 descriptive cross-sectional studies. Evidence was summarized from 7 aspects,including access selection,elimination of other interference factors,patient position,sensor zero calibration and position,analysis of waveform and accurate reading,equipment management and personnel training,and 30 pieces of best evidence were formed. Conclusion This paper summarizes the best evidence of relevant operating techniques of CVP electronic measurement,which provides an evidence basis for improving the accuracy and operation standardization of clinical CVP measurement.

Key words: Central Venous Pressure, Hemodynamic Monitoring, Operation Instructions, Evidence-Based Nursing

赵明曦, 李奇, 罗红波, 孙建华, 李尊柱, 米元元, 朱艳萍, 何怀武, 李真, 路经纬, 吕洪维, 孙红. 中心静脉压测量的最佳证据总结[J]. 中华护理杂志, 2021, 56(10): 1552-1559.

ZHAO Mingxi, LI Qi, LUO Hongbo, SUN Jianhua, LI Zunzhu, MI Yuanyuan, ZHU Yanping, HE Huaiwu, LI Zhen, LU Jingwei, LÜ Hongwei, SUN Hong. Measurement techniques of central venous pressure in adult patients:a summary of best evidence[J]. Chinese Journal of Nursing, 2021, 56(10): 1552-1559.

图/表 4

图1 文献筛选流程图

Figure 1 Literature screening flow chart

表1 纳入文献的一般特征

Table 1 General characteristics included in the literature

表2 指南的质量评价结果

Table 2 The quality evaluation results of the guidelines

表3 中心静脉压测量的证据汇总

Table 3 Summary of evidence on central venous pressure measurement technology

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