肿瘤靶向治疗患者皮肤不良反应预防及管理的证据总结

doi:10.3761/j.issn.0254-1769.2022.09.006

摘要/Abstract

摘要：

目的遴选并总结肿瘤靶向治疗患者皮肤不良反应预防及管理的最佳证据,为临床决策提供参考。方法计算机检索BMJ最佳临床实践、UpToDate临床决策系统、乔安娜布里格斯研究所循证卫生保健中心数据库、国际指南协作网、英国国家卫生与临床优化研究所、苏格兰院际指南网、医脉通指南网、美国国立临床诊疗指南数据库、美国医疗保健与研究质量局、加拿大安大略注册护士协会、世界肿瘤学网站、美国国家癌症综合网站、中国抗癌协会肺癌专业委员会、中国抗癌协会肿瘤护理专业委员协会、Cochrane Library、Embase、CHINAL、Web of Science、OVID、PubMed、SinoMed、中国知网、万方数据和维普数据库等相关网站,检索关于肿瘤靶向治疗患者皮肤不良反应预防及管理的指南、证据总结、最佳实践、专家共识、系统评价及原始研究。检索时限为2011年1月1日—2021年10月3日。由2名研究者进行文献质量评价和资料提取。结果共纳入15篇文献,其中3篇指南、4篇证据总结、1篇系统评价、3篇随机对照试验、1篇类实验研究和3篇专家共识,围绕皮肤评估、危险因素、药物治疗、皮肤护理、皮肤不良反应处理、健康教育等6个方面形成19条最佳证据。结论该研究总结了肿瘤靶向治疗患者皮肤不良反应预防及管理的最佳证据,为医护人员提供循证依据,医护人员应结合临床情景,充分评估患者皮肤状况,做好皮肤方面的健康教育、检查和护理,预防皮肤不良反应的发生。

关键词: 肿瘤, 靶向治疗, 不良反应, 皮肤护理, 证据总结, 循证护理学

Abstract:

Objective To select and summary the best evidence on prevention and management of the skin adverse reactions in patients with targeted tumor therapy,and to provide references for clinical decision. Methods We systematically searched for the evidence on prevention and management of the skin adverse reactions in patients with targeted tumor therapy in BMJ best practice,UpToDate clinical decision system,Joanna Briggs Institute,Guidelines International Network,National Institute for Health and Clinical Excellence,Scottish Intercollegiate Guidelines Network,Yi Maitong Guidelines Network,National Guideline Clearinghouse,the Agency for Healthcare Research and Quality,Registered Nurses’ Association of Ontario,World Oncology Network,National Comprehensive Cancer Network,Lung Cancer Committee of China Anti-Cancer Association,Chinese Anti-Cancer Association Oncologic Nursing Comittee,Cochrane Library,Embase,CHINAL,Web of Science,OVID,PubMed,SinoMed,CNKI,WanFang database,VIP database to collect the literature,including clinical guidelines,evidence summaries,best practice information sheets,recommended practice,systematic reviews and original research. The retrieval period was from January 1,2011 to October 3,2021.There were 2 researchers evaluating the quality of the literature and extracting the data. Results 15 articles were selected,including 3 guidelines,4 evidence summaries,1 systematic reviews,3 randomized controlled trials,1 class experiment and 3 expert consensuses. 19 pieces of best evidence were formed from 6 aspects,including skin evaluation,risk factors,drug therapy,skin care,skin adverse reaction management and health education. Conclusion This study summarizes the best evidence on management and prevention of skin adverse reactions in patients with targeted tumor therapy,and provides evidence-based evidence for clinical workers and managers. It is suggested that clinical staff should combine clinical context,fully assess patient’s skin condition,do a good job of skin health education,examination and care to prevent the occurrence of skin adverse reactions.

Key words: Neoplasm, Targeted Therapy, Adverse Reactions, Skin Nursing, Evidence Summary, Evidence-Based Nursing

胡丽莎, 彭红华, 米元元, 曹咪, 胡敏, 祝玲, 喻红君, 彭淑华. 肿瘤靶向治疗患者皮肤不良反应预防及管理的证据总结[J]. 中华护理杂志, 2022, 57(9): 1061-1069.

HU Lisha, PENG Honghua, MI Yuanyuan, CAO Mi, HU Min, ZHU Ling, YU Hongjun, PENG Shuhua. Evidence summary for prevention and management of the skin adverse reactions in patients with targeted tumor therapy[J]. Chinese Journal of Nursing, 2022, 57(9): 1061-1069.

图/表 5

图1 PubMed 检索策略

Figure 1 PubMed search strategy

图2 文献筛选流程图注：BMJ为最佳临床实践、JBI为乔安娜布里格斯研究所、GIN为国际指南协作网、NICE为英国国家卫生与临床优化研究所、SIGN为苏格兰院际指南网、NGC为美国国立临床诊疗指南数据库、AHRQ为美国医疗保健与研究质量局、RNAO为加拿大安大略注册护士协会、WON为世界肿瘤学网站、NCCN为美国国家癌症综合网站、CACAONC为中国抗癌协会肿瘤护理专业委员协会。

Figure 2 Flow chart of literature screening

表1 纳入文献的一般特征（n=15）

Table 1 Characteristics of included studies（n=15）

表2 指南质量评价结果

Table 2 Study quality assessed by AGREEⅡ

表3 肿瘤靶向治疗患者皮肤不良反应预防及管理的最佳证据总结

Table 3 Evidence summary for the best prevention and management of the skin adverse reactions in patients with targeted tumor therapy

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