肠造口周围潮湿相关性皮肤损伤预防与管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.02.017

摘要/Abstract

摘要：

目的检索国内外肠造口周围潮湿相关性皮肤损伤预防与管理的相关证据,并对最佳证据进行汇总,为制订科学合理的造口周围皮肤护理方案提供参考。方法按照循证资源6S模型自上而下的原则,系统检索国内外数据库和网站关于肠造口周围潮湿相关性皮肤损伤预防与管理的证据,包括指南、最佳临床实践信息手册、证据总结、专家共识、系统评价及标准,检索时限为建库至2021年5月。由2名经系统循证知识培训的研究人员对文献质量进行评价,并结合专业判断,选取符合纳入标准的文献,并提取证据。结果共纳入14篇文献,包括临床决策支持1篇、指南3篇、标准1篇、证据总结3篇、系统评价3篇、专家共识3篇。总结的最佳证据包括定位、评估、清洗、肠造口护理用品的选择与使用、肠造口周围皮肤护理、健康教育与随访6个方面的20条推荐意见。结论该研究总结的肠造口周围潮湿相关性皮肤损伤预防与管理的最佳证据具有一定的科学性与实用性,可为临床医护人员有针对性地开展证据应用提供循证依据。

关键词: 肠造口术, 潮湿相关性皮肤损伤, 预防, 证据总结, 护理

Abstract:

Objective To retrieve the relevant evidence for the prevention and management of peristomal moisture-associated skin damage（PMASD） in adults,and to summarize the best evidence to provide a reference for formulating a scientific and reasonable skin care plan around the stoma. Methods According to the top-down principle of the evidence-based resource 6S model,a systematic search of domestic and foreign databases and websites was conducted on the prevention and management of PMASD in adults,including clinical practice guidelines,best clinical practice information manuals,evidence summaries,expert consensuses,systematic reviews,and standards. The search time limit was from the establishment of the databases to May 2021. 2 trained researchers in systematic evidence-based knowledge evaluated the quality of the literature,combined with professional judgment,selected the literature that met the inclusion and exclusion criteria,and extracted the evidence. Results A total of 14 articles were included,including 1 clinical decision support article,3 guidelines,1 standard,3 evidence summaries,3 systematic reviews,and 3 expert consensuses. The best evidence includes 20 recommendations in 6 aspects,namely positioning,evaluation,cleaning,selection and use of ostomy care products,skin care around the ostomy,and health education and the follow-up. Conclusion This study summarizes the best evidence for the prevention and management of PMASD in adults,and provides evidence-based references for clinical medical staff to carry out the application of targeted evidence.

Key words: Ostomy, Moisture-Associated Skin Damage, Prevention, Evidence Summary, Nursing Care

董珊, 袁玲, 陈秋菊, 吴玲, 魏敏, 张倩文. 肠造口周围潮湿相关性皮肤损伤预防与管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(2): 223-229.

DONG Shan, YUAN Ling, CHEN Qiuju, WU Ling, WEI Min, ZHANG Qianwen. Summary of the best evidence for the prevention and management of peristomal moisture-associated skin damage in adults[J]. Chinese Journal of Nursing, 2022, 57(2): 223-229.

图/表 4

表1 纳入文献的一般资料

Table 1 Characteristics of the included studies

表2 指南的质量评价结果

Table 2 Quality evaluation of clinical practice guidelines

表3 系统评价的质量评价结果

Table 3 Quality evaluation of systematic reviews

表4 成人肠造口周围潮湿相关性皮肤损伤预防与管理的最佳证据

Table 4 Summary of the best evidence for the prevention and management of peristomal moisture-associated skin damage in adults

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