下肢静脉溃疡患者自我管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.06.015

摘要/Abstract

摘要：

目的检索、评价和总结下肢静脉溃疡患者自我管理的相关证据,为护理人员健康宣教及患者自我管理提供循证依据。方法系统检索指南网站、数据库、专业协会网站中所有关于下肢静脉溃疡患者自我管理内容的相关文献,包括指南、最佳实践、专家共识、证据总结、系统评价、原始研究,检索时限为建库至2021年8月1日。由2名研究者独立对纳入文献进行质量评价,并结合专业人士的判断,进行证据的提取与整合。结果共纳入14篇文献,其中,指南9篇,最佳实践2篇,系统评价2篇,专家共识1篇。最终总结出21条最佳证据,包括患者自我评估、压力治疗管理、饮食营养管理、运动管理、伤口周围皮肤管理5个方面。结论该研究总结的下肢静脉溃疡患者自我管理的最佳证据具有科学性和实用性,可为临床医护人员提供参考和借鉴,使其更有针对性、科学性地指导下肢静脉溃疡患者的自我管理行为。

关键词: 下肢静脉溃疡, 自我管理, 健康教育, 证据总结, 循证护理学

Abstract:

Objective To retrieve,evaluate and summarize the evidence of self-management of patients with venous leg ulcer（VLU）,and to provide evidence-based references for health education and self-management of patients.Methods We systematically searched all relevant literature on the self-management of patients with VLU,including clinical practice guidelines,best practices,expert consensuses,evidence summaries,systematic reviews and original studies,from the guideline websites,databases and professional association websites,with the search period from the database establishment to August 2021. 2 researchers independently evaluated the quality of the included literature,and extracted and integrated evidence based on the judgment of professionals.Results A total of 14 articles were included,including 9 guidelines,2 best practices,2 systematic reviews and 1 expert consensus. Finally,21 pieces of best evidence were summarized,including 5 aspects of patient self-assessment,stress management,diet and nutrition management,exercise management,and skin management around the wound.Conclusion This study summarizes the best evidence of self-management of patients with VLU,and clinical medical staff can use the best evidence to guide the self-behavior management of patients with VLU in a more targeted and scientific way.

Key words: Venous Leg Ulcers, Self-Management, Health Education, Evidence Summary, Evidence-Based Nursing

穆文方, 王娴, 肖星婷, 王燕, 许志玮. 下肢静脉溃疡患者自我管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(6): 740-747.

MU Wenfang, WANG Xian, XIAO Xingting, WANG Yan, XU Zhiwei. Summary of the best evidence for self-management in patients with venous leg ulcer[J]. Chinese Journal of Nursing, 2022, 57(6): 740-747.

图/表 4

表1 纳入文献的一般特征

Table 1 Characteristics of included studies

表2 指南及最佳实践的质量评价结果

Table 2 Quality evaluation of guidelines

表3 系统评价的质量评价结果

Table 3 Quality evaluation of the systematic reviews

表4 下肢静脉溃疡患者自我管理的最佳证据总结

Table 4 Summary of the best evidence for self-management in patients with venous leg ulcers

参考文献 44

[1]	O’Donnell TFJ, Passman MA, Marston WA, et al. Management of venous leg ulcers:clinical practice guidelines of the Society for Vascular SurgeryR and the American Venous Forum[J]. J Vasc Surg, 2014, 60(2 Suppl):3s-59s. DOI URL
[2]	Posnett J, Gottrup F, Lundgren H, et al. The resource impact of wounds on healthcare providers in Europe[J]. J Wound Care, 2009, 18(4):154-161. PMID
[3]	Ratliff CR, Yates S, McNichol L, et al. Compression for primary prevention,treatment,and prevention of recurrence of venous leg ulcers:an evidence-and consensus-based algorithm for care across the continuum[J]. J Wound Ostomy Continence Nurs, 2016, 43(4):347-364. DOI URL
[4]	Probst S, Weller CD, Bobbink P, et al. Prevalence and incidence of venous leg ulcers-a protocol for a systematic review[J]. Syst Rev, 2021, 10(1):148. DOI PMID
[5]	Kelechi TJ, Brunette G, Bonham PA, et al. 2019 guideline for management of wounds in patients with lower-extremity venous disease(LEVD):an executive summary[J]. J Wound Ostomy Continence Nurs, 2020, 47(2):97-110. DOI URL
[6]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. Composition of different types of evidence-based questions[J]. J Nurses Train, 2017, 32(21):1991-1994.
[7]	Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009, 12(4):99-101. DOI PMID
[8]	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ:advanc-ing guideline development,reporting and evaluation in health care[J]. Cmaj, 2010, 182(18):E839-842. DOI URL
[9]	崔世超, 侯海燕, 李幼平, 等. 不孕症临床指南的系统评价[J]. 中国循证医学杂志, 2013, 13(8):947-954.
	Cui SC, Hou HY, Li YP, et al. Systematic evaluation of clinical guidelines for infertility[J]. Chin J Evidence-based Medicine, 2013, 13(8):947-954.
[10]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具——系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. Quality evaluation tool for different types of studies in JBI evidence-based health care center:methodological quality evaluation of systematic evaluation[J]. J Nurses Train, 2018, 33(8):701-703.
[11]	Health Service Executive. HSE national wound management guidelines 2018[EB/OL].(2018-05-24)[2021-07-30]. https://healthservice.hse.ie/filelibrary/onmsd/hse-national-wound-management-guidelines-2018.pdf.
[12]	Franks PJ, Barker J, Collier M, et al. Management of patients with venous leg ulcers:challenges and current best practice[J]. J Wound Care, 2016, 25(Suppl 6):S1-S67.
[13]	The Australian Wound Management Association,the New Zealand Wound Care Society. Australian and New Zealand clinical practice guidelines for prevention and management of venous leg ulcers[EB/OL]. (2011-10-01)[2021-07-30]. https://www.nzw-cs.org.nz/images/luag/2011_awma_vlug.pdf.
[14]	Mosti G, Partsch H. Compression stockings with a negative pressure gradient have a more pronounced effect on venous pumping function than graduated elastic compression stockings[J]. Eur J Vasc Endovasc Surg, 2011, 42(2):261-266. DOI URL
[15]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-grading and evidence recom-mendation level system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[16]	Neumann HAM, Cornu-Thenard A, Junger M, et al. Evidence ba-sed(S3) guidelines for diagnostics and treatment of venous leg ulcers[J]. J Eur Acad Dermatol Venereol, 2016, 30(11):1843-1875. DOI URL
[17]	Association for the Advancement of Wound Care. International consolidated venous ulcer guideline(ICVUG) 2015 (update of AAWC venous ulcer guideline,2005 and 2010)[EB/OL].(2015-12-25)[2021-07-30]. https://aawconline.memberclicks.net/assets/appendix%20c%20guideline%20icvug-textformatrecommendations-final%20v42%20changessaved18aug17.pdf.
[18]	The European Society for Vascular Surger. Editor’s choice- management of chronic venous disease clinical practice gui-delines of the European Society for Vascular Surgery(ESVS)[EB/OL].(2015-04-25)[2021-07-30]. https://www.ejves.com/action/showPdf?pii=S1078-5884%2815%290 .
[19]	Scottish Intercollegiate Guidelines Network. Management of chronic venous leg ulcers[EB/OL]. (2010-08-01)[2021-07-30]. https://www.sign.ac.uk/media/1058/sign120.pdf.
[20]	陈忠, 王深明, 姚陈. 中国慢性静脉疾病诊断与治疗指南[J]. 中华医学杂志, 2019, 99(39):3047-3061.
	Chen Z, Wang SM, Yao C. Diagnosis and treatment of chronic venous diseases in China[J]. Chin J Med, 2019, 99(39):3047-3061.
[21]	Wounds International. Best practice recommendations for holistic strategies to promote and maintain skin integrity[EB/OL]. (2020-03-04)[2021-07-30]. https://www.woundsinternational.com/resources/details/best-practice-recommendations-holistic-stra-tegies-promote-and-maintain-skin-integrity.
[22]	Boersema GC, Smart H, Giaquinto-Cilliers MGC, et al. Management of nonhealable and maintenance wounds:a systematic integrative review and referral pathway[J]. Adv Skin Wound Care, 2021, 34(1):11-22. DOI URL
[23]	Dini V, Janowska A, Oranges T, et al. Surrounding skin management in venous leg ulcers:a systematic review[J]. J Tissue Viability, 2020, 29(3):169-175. DOI URL
[24]	Wounds International. Simplifying venous leg ulcer manage-ment[EB/OL].(2015-05-08)[2021-07-30]. https://www.3mlear-ning.co.uk/media/1072/3m_14_4_consensus_web.pdf.
[25]	Cho SK, Mattke S, Gordon H, et al. Development of a model to predict healing of chronic wounds within 12 weeks[J]. Adv Wound Care(New Rochelle), 2020, 9(9):516-524.
[26]	Parker CN, Finlayson KJ, Edwards HE. Predicting the likeli-hood of delayed venous leg ulcer healing and recurrence:development and reliability testing of risk assessment tools[J]. Ostomy Wound Management, 2017, 63(10):16-26.
[27]	郑宏娟, 张佩英. 下肢静脉溃疡压力治疗的证据总结[J]. 中华护理教育, 2020, 17(11):1046-1051.
	Zheng HJ, Zhang PY. A review of evidence on pressure therapy for venous ulcer of lower extremity[J]. Chin J Nurs Educ, 2020, 17(11):1046-1051.
[28]	李飞, 南方, 党芸, 等. 充气加压治疗对下肢静脉性溃疡患者伤口愈合效果的Meta分析[J]. 中华护理杂志, 2021, 56(6):929-934.
	Li F, Nan F, Dang Y, et al. Effect of inflatable compression therapy on wound healing in patients with venous ulcer of lower extremities:a meta-analysis[J]. Chin J Nurs, 2021, 56(6):929-934.
[29]	Kapp S, Miller C, Donohue L. The clinical effectiveness of two compression stocking treatments on venous leg ulcer recurrence:a randomized controlled trial[J]. Int J Low Extrem Wounds, 2013, 12(3):189-198. DOI URL
[30]	Barber GA, Weller CD, Gibson SJ. Effects and associations of nutrition in patients with venous leg ulcers:a systematic review[J]. J Adv Nurs, 2018, 74(4):774-787. DOI URL
[31]	Bolton L. Exercise and chronic wound healing[J]. Wounds, 2019, 31(2):65-67. PMID
[32]	Cho SK, Mattke S, Gordon H, et al. Development of a model to predict healing of chronic wounds within 12 weeks[J]. Adv Wound Care(New Rochelle), 2020, 9(9):516-524.
[33]	Finlayson KJ, Parker CN, Miller C, et al. Predicting the likelihood of venous leg ulcer recurrence:the diagnostic accuracy of a newly developed risk assessment tool[J]. Int Wound J, 2018, 15(5):686-694. DOI PMID
[34]	刘鑫, 江锦芳, 林桦, 等. 下肢肌肉训练计划在下肢静脉溃疡患者创面治疗中的应用[J]. 解放军护理杂志, 2021, 38(2):14-17.
	Liu X, Jiang JF, Lin H, et al. Application of lower limb muscle training program in wound treatment of patients with lower limb venous ulcer[J]. Nurs J Chin PLA, 2021, 38(2):14-17.
[35]	Dix FP, Reilly B, David MC, et al. Effect of leg elevation on healing,venous velocity and ambulatory venous pressure in venous ulceration[J]. Phlebology, 2005, 20(2):87-94. DOI URL
[36]	Moore ZE, Cowman S. Wound cleansing for pressure ulcers[J]. Cochrane Database Syst Rev, 2013, 2013(3):CD004983.
[37]	Lichterfeld-Kottner A, El Genedy M, Lahmann N, et al. Maintaining skin integrity in the aged:a systematic review[J]. Int J Nurs Stud, 2020, 103:103509. DOI PMID
[38]	Beeckman D, Van Damme N, Schoonhoven L, et al. Interventions for preventing and treating incontinence-associated dermatitis in adults[J]. Cochrane Database Syst Rev, 2016, 11(11):Cd011627.
[39]	Gray M, Beeckman D, Bliss DZ, et al. Incontinence-associated dermatitis:a comprehensive review and update[J]. J Wound Ostomy Continence Nurs, 2012, 39(1):61-74. DOI URL
[40]	Wounds UK. All-Wales guidance for the prevention and management of skin tears[EB/OL]. [2021-07-30]. https://www.wounds-uk.com/resources/details/prevention-and-management-skin-tears.
[41]	Carville K, Leslie G, Osseiran-Moisson R, et al. The effectiveness of a twice-daily skin-moisturising regimen for reducing the incidence of skin tears[J]. Int Wound J, 2014, 11(4):446-453. DOI PMID
[42]	Wilson JR, Mills JG, Prather ID, et al. A toxicity index of skin and wound cleansers used on in vitro fibroblasts and kera-tinocytes[J]. Adv Skin Wound Care, 2005, 18(7):373-378. PMID
[43]	Thomas GW, Rael LT, Bar-Or R, et al. Mechanisms of delayed wound healing by commonly used antiseptics[J]. J Trauma, 2009, 66(1):82-90.
[44]	董珊, 袁玲, 陈秋菊, 等. 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):223-230.
	Dong S, Yuan L, Chen QJ, et al. Summary of the best evide-nce for the prevention and management of peristomal moisture-associated skin damage in adults[J]. Chin J Nurs, 2022, 57(2):223-230.