基于最佳证据的腹膜透析患者运动指导流程图的制作

doi:10.3761/j.issn.0254-1769.2022.11.015

摘要/Abstract

摘要：

目的评价并总结腹膜透析患者运动干预相关证据,根据最佳证据制作腹膜透析患者运动指导流程图,为临床护士指导腹膜透析患者运动锻炼提供依据。方法计算机检索WHO网站、BMJ（Best Practice）、英国国家卫生与临床优化研究所网站、国际指南协作网、苏格兰校际指南网站、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、美国国立指南库、UpToDate、Embase、PubMed、Web of Science、Cochrane Library、中国生物医学文献数据库、医脉通、中国知网、万方数据库、维普数据库中关于腹膜透析患者运动锻炼的相关文献。检索时间为建库至2021年11月1日。对文献质量进行评价,提取整合、评审证据;采用专家小组会议法制作运动指导流程图。结果最终纳入5篇文献,4篇为系统评价及Meta分析,1篇为专家共识。总结包括评估时间、评估内容、评估工具、运动类型、运动强度、运动频率、运动时间、注意事项8个方面的内容,22条最佳证据,并制作了腹膜透析患者运动指导流程图。结论该研究总结了腹膜透析患者运动相关的最佳证据,并根据最佳证据制作运动指导流程图,可为临床医护人员指导腹膜透析患者运动锻炼提供参考。

关键词: 腹膜透析, 肾功能不全, 运动, 流程图, 循证护理学

Abstract:

Objective To evaluate and summarize the relevant evidence of exercise intervention in peritoneal dialysis patients,so as to provide evidence-based bases for making the exercise guidance flow chart of peritoneal dialysis patients. According to the best evidence,the exercise guidance flow chart of peritoneal dialysis patients is made to facilitate clinical nurses to guide the exercise of peritoneal dialysis patients. Methods The computer search includes the World Health Organization,BMJ（best practice）,the website of the National Institute for health and clinical optimization,the international guidelines collaboration network,the Scottish inter school guidelines website,the Joanna Briggs Institute（JBI）,the U.S. national guidelines library,up to date,Embase,PubMed,Web of Science,Cochrane Library. Relevant literature on exercise of peritoneal dialysis patients in China biomedical literature database,Yimaitong,China knowledge network,Wanfang database and VIP database. The retrieval time is from the establishment of the database to November 1,2021. The quality of literature was evaluated and the evidence was extracted. The expert group meeting method was conducted to integrate the evidence and the flow chart of sports guidance was made. Results Finally,5 pieces of the literature were included,among which 4 were systematic reviews and 1 was expert consensus. The summary includes 8 aspects of exercise type,time,intensity,frequency,evaluation time,evaluation content,evaluation tools and precautions,22 pieces of best evidence,and the exercise guidance flow chart of peritoneal dialysis patients is made. Conclusion This study summarizes the best evidence related to exercise in peritoneal dialysis patients,and makes the exercise guidance process according to the best evidence,so as to provide references for clinical medical staff to guide exercise in peritoneal dialysis patients.

Key words: Peritoneal Dialysis, Renal Insufficiency, Exercise, The Flow Chart, Evidence-Based Nursing

范美荣, 陈璐, 王芸, 张凤, 何磊. 基于最佳证据的腹膜透析患者运动指导流程图的制作[J]. 中华护理杂志, 2022, 57(11): 1377-1383.

FAN Meirong, CHEN Lu, WANG Yun, ZHANG Feng, HE Lei. Development of exercise guidance flow chart for peritoneal dialysis patients based on the best evidence[J]. Chinese Journal of Nursing, 2022, 57(11): 1377-1383.

图/表 6

图1 文献筛选流程

Figure 1 flow chart of literature search and screening

表1 纳入文献的基本特征（n=5）

Table 1 Characteristics of included literatures（n=5）

表2 纳入系统评价及Meta分析的质量评价结果（n=4）

Table 2 Literature quality evaluation results of systematic review and Meta-analysis（n=4）

表3 腹膜透析患者运动指导的最佳证据汇总

Table 3 Summary of the best evidence for exercise instruction in peritoneal dialysis patients

表4 专家小组会议结果（n=10）

Table 4 results of expert group meetings（n=10）

图2 腹膜透析患者运动指导流程图注：RPE为Borg主观疲劳感觉评分;6MWT为6 min 步行实验。

Figure 2 Flow chart of exercise instruction for peritoneal dialysis patients

参考文献 35

[1]	葛均波, 徐永健, 王辰. 内科学[M]. 9版. 北京: 人民卫生出版社, 2018:218-256.
	Ge JB, Xu YJ, Wang C. Internal medicine[M]. 9th ed. Beijing: People’s Medical Publishing House, 2018:218-256.
[2]	Manfredini F, Mallamaci F, D’Arrigo G, et al. Exercise in patients on dialysis:a multicenter,randomized clinical trial[J]. J Am Soc Nephrol, 2017, 28(4):1259-1268. DOI PMID
[3]	朱为模. 运动处方的过去、现在与未来[J]. 体育科研, 2020, 41(1):1-18.
	Zhu WM. The past,present and future of exercise prescription[J]. Sport Sci Res, 2020, 41(1):1-18.
[4]	吴冬春, 胡雁, 周文琴, 等. 中青年腹膜透析患者在职体验的研究[J]. 中华护理杂志, 2016, 51(3):284-288.
	Wu DC, Hu Y, Zhou WQ, et al. Qualitative research on the job experience of youth and middle-aged patients with peritoneal dialysis[J]. Chin J Nurs, 2016, 51(3):284-288.
[5]	王青尔, 孙慧敏, 周婷婷, 等. 腹膜透析患者社会功能及影响因素研究[J]. 中华护理杂志, 2016, 51(6):707-711.
	Wang QE, Sun HM, Zhou TT, et al. Social function and its influencing factors of peritoneal dialysis patients[J]. Chin J Nurs, 2016, 51(6):707-711.
[6]	杜理平, 单岩, 李艳艳, 等. 中青年腹膜透析病人居家运动现况及影响因素分析[J]. 护理研究, 2019, 33(19):3427-3431.
	Du LP, Shan Y, Li YY, et al. Status quo and influencing factors of home-based exercise in young and middle-aged peritoneal dialysis patients[J]. Chin Nurs Res, 2019, 33(19):3427-3431.
[7]	Jegatheesan DK, Modderman R, Krishnasamy R, et al. A systematic review of scope and consistency of outcome measures for physical fitness in chronic kidney disease trials[J]. Kidney Int Rep, 2021, 6(5):1280-1288. DOI PMID
[8]	Cupisti A, D’Alessandro C, Caselli GM, et al. Nutritional and functional assessment of peritoneal dialysis patients in the clinical practice:report from MITO-DP Group[J]. G Ital Nefrol, 2016, 33(4):gin/33.4.6.
[9]	Painter PL, Agarwal A, Drummond M. Physical function and physical activity in peritoneal dialysis patients[J]. Perit Dial Int, 2017, 37(6):598-604. DOI URL
[10]	Bennett PN, Hussein WF, Matthews K, et al. An exercise program for peritoneal dialysis patients in the United States:a feasibility study[J]. Kidney Med, 2020, 2(3):267-275. DOI URL
[11]	Deligiannis A, D’Alessandro C, Cupisti A. Exercise training in dialysis patients:impact on cardiovascular and skeletal muscle health[J]. Clin Kidney J, 2021, 14(Suppl 2):ii25-ii33. DOI PMID
[12]	Nakamura K, Sasaki T, Yamamoto S, et al. Effects of exercise on kidney and physical function in patients with non-dialysis chronic kidney disease:a systematic review and meta-analysis[J]. Sci Rep, 2020, 10:18195. DOI PMID
[13]	Wu LH, Liu Y, Wu L, et al. Effects of exercise on markers of inflammation and indicators of nutrition in patients with chronic kidney disease:a systematic review and meta-analysis[J]. Int Urol Nephrol, 2021:1-12.
[14]	Isnard-Rouchon M, West M, Bennett PN. Exercise and physical activity for people receiving peritoneal dialysis:why not?[J]. Semin Dial, 2019, 32(4):303-307. DOI URL
[15]	Takkavatakarn K, Wuttiputinun T, Phannajit J, et al. Protein-bound uremic toxin lowering strategies in chronic kidney disease:a systematic review and meta-analysis[J]. J Nephrol, 2021, 34(6):1805-1817. DOI PMID
[16]	宋欣芫, 郝洁, 肖莉, 等. 护理专案改善在提高门诊慢性肾脏病患者自我管理能力中的应用研究[J]. 中华护理杂志, 2017, 52(6):692-697.
	Song XY, Hao J, Xiao L, et al. Application of nursing project in improving self-management ability of outpatients with chronic kidney disease[J]. Chin J Nurs, 2017, 52(6):692-697.
[17]	Alper BS, Haynes RB. EBHC pyramid 5.0 for accessing prea-ppraised evidence and guidance[J]. Evid Based Med, 2016, 21(4):123-125. DOI URL
[18]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018:56-93.
	Hu Y, Hao YF. Evidence based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018:56-93.
[19]	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-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[20]	Afsar B, Siriopol D, Aslan G, et al. The impact of exercise on physical function,cardiovascular outcomes and quality of life in chronic kidney disease patients:a systematic review[J]. Int Urol Nephrol, 2018, 50(5):885-904. DOI URL
[21]	Thangarasa T, Imtiaz R, Hiremath S, et al. Physical activity in patients treated with peritoneal dialysis:a systematic review and meta-analysis[J]. Can J Kidney Health Dis, 2018, 5:205-4358118779821.
[22]	Clarkson MJ, Bennett PN, Fraser SF, et al. Exercise interventions for improving objective physical function in patients with end-stage kidney disease on dialysis:a systematic review and meta-analysis[J]. Am J Physiol Renal Physiol, 2019, 316(5):F856-F872. DOI URL
[23]	Bohm C, Schick-Makaroff K, MacRae JM, et al. The role of exercise in improving patient-reported outcomes in individuals on dialysis:a scoping review[J]. Semin Dial, 2019, 32(4):336-350. DOI URL
[24]	中国医师协会康复医师分会肾康复专业委员会, 马迎春. 我国成人慢性肾脏病患者运动康复的专家共识[J]. 中华肾脏病杂志, 2019(7):537-543.
	Chinese Medical Doctor Association Rehabilitation Physicians Branch, Professional Committee of Renal Rehabilitation, Ma YC. Expert consensus on exercise rehabilitation for Chinese adults with chronic kidney disease[J]. Chin J Ne-phrol, 2019(7):537-543.
[25]	Jamnick NA, Pettitt RW, Granata C, et al. An examination and critique of current methods to determine exercise intensity[J]. Sports Med, 2020, 50(10):1729-1756. DOI URL
[26]	Chan WLS, Pin TW. Reliability, validity and minimal detectable change of 2-minute walk test,6-minute walk test and 10-meter walk test in frail older adults with dementia[J]. Exp Gerontol, 2019, 115:9-18. DOI URL
[27]	唐青, 郭瑜洁. 慢性肾脏病患者运动康复的研究进展[J]. 中华护理杂志, 2016, 51(8):984-988.
	Tang Q, Guo YJ. Research progress of exercise training in patients with chronic kidney disease[J]. Chin J Nurs, 2016, 51(8):984-988.
[28]	Uchiyama K, Washida N, Morimoto K, et al. Effects of exercise on residual renal function in patients undergoing peritoneal dialysis:a post-hoc analysis of a randomized controlled trial[J]. Ther Apher Dial, 2020, 24(6):668-676. DOI URL
[29]	Zhang LJ, Wang YY, Xiong LL, et al. Exercise therapy improves eGFR,and reduces blood pressure and BMI in non-dialysis CKD patients:evidence from a meta-analysis[J]. BMC Nephrol, 2019, 20(1):398. DOI URL
[30]	Collao N, Rada I, Francaux M, et al. Anti-inflammatory effect of exercise mediated by toll-like receptor regulation in innate immune cells - a review[J]. Int Rev Immunol, 2020, 39(2):39-52. DOI URL
[31]	Hiraki K, Shibagaki Y, Izawa KP, et al. Effects of home-based exercise on pre-dialysis chronic kidney disease patients:a randomized pilot and feasibility trial[J]. BMC Nephrol, 2017, 18(1):198. DOI PMID
[32]	Dziubek W, Kowalska J, Kusztal M, et al. The level of anxiety and depression in dialysis patients undertaking regular physical exercise training:a preliminary study[J]. Kidney Blood Press Res, 2016, 41(1):86-98. DOI URL
[33]	莫选菊, 张晓, 彭继海, 等. 抗阻运动对特发性炎性肌病患者肌肉适能和生活质量的影响[J]. 护理学杂志, 2018, 33(20):4-7.
	Mo XJ, Zhang X, Peng JH, et al. Effects of anti-resistance exercise on muscle fitness and quality of life in patients with idiopathic inflammatory myopathy[J]. J Nurs Sci, 2018, 33(20):4-7.
[34]	林基伟. 八段锦对腹膜透析患者临床疗效影响的非随机对照研究[D]. 广州: 广州中医药大学, 2017.
	Lin JW. Effect of baduanjin on the clinical efficacy in the patients of peritoneal dialysis:a non-randomized controlled trial[D]. Guangzhou: Guangzhou University of Chinese Medici-ne, 2017.
[35]	上月正博. 腎臓リハビリテーションの効果と実際―運動制限から運動療法へ[J]. Japanese J Rehabilit Med, 2018, 55(8):682-689.
	M Kohzuki. The effectiveness and reality of renal rehabilitation-from restricted exercise to exercise therapy[J]. Japan J Rehabilit Med, 2018, 55(8):682-689.