重症患者经膀胱腹内压监测管理的证据总结

doi:10.3761/j.issn.0254-1769.2022.15.014

摘要/Abstract

摘要：

目的评价并总结重症患者经膀胱腹内压监测管理的相关证据,为临床实践提供参考。方法提出循证问题,并系统检索BMJ循证医学库、UpToDate、Cochrane Library、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、英国国家卫生与临床优化研究所网站、美国国立指南库、国际指南协作网、苏格兰学院间指南网、医脉通、加拿大安大略注册护士协会网站、PubMed、中国知网、中国生物医学文献数据库、万方数据库、维普数据库、世界腹腔间隙综合征协会与中国腹腔重症协作组网站等关于经膀胱腹内压监测管理方面的指南、专家共识、证据总结、系统评价等证据,检索时间为建库至2021年6月,由2名研究人员独立对文献进行质量评价和证据级别评定。结果共纳入6篇文献,包括4篇指南、1篇专家共识、1篇推荐实践,从体位、零点位置、生理盐水灌注量、监测时机及频率、镇静镇痛方案的使用5个方面汇总11条最佳证据。结论该研究规范了经膀胱腹内压监测的方法,有利于提高监测结果的准确性,可为重症患者经膀胱腹内压监测提供参考。医护人员需结合临床情境,考虑患者意愿,审慎地选用证据,从而提高经膀胱腹内压监测结果的准确性,提高护理质量。

关键词: 重症患者, 腹内压, 监测管理, 循证护理学

Abstract:

Objective To evaluate and summarize the best evidence for the monitoring and management of intra-abdominal pressure via bladder in critically ill patients,and to provide references for clinical practice. Methods We systematically searched the guideline websites,databases and association official websites to collect the literature including guidelines,expert consensuses,evidence summaries,systematic reviews,and other literature after proposing the evidence-based questions. The databases included BMJ Best Practice,UpToDate,Cochrane Library,Joanna Briggs Institute（JBI） Library,National Institute for Health and Clinical Excellence（NICE）,National Guideline Clearinghouse（NGC）,Guideline International Network（GIN）,Scottish Intercollegiate Guidelines Network（SIGN）,Medlive.cn,Registered Nurses’ Association of Ontario（RNAO）,PubMed,CNKI,CINAHL,SinoMed,Wanfang Database,VIP Database,the Abdominal Compartment Society（WSACS） and Chinese Abdominal Intensive Care Association（CAICA）,etc. The retrieval period was from the inception of the databases to June 30,2021. There were 2 researchers who independently assessed the quality of the literature and identified the level of evidence. Results A total of 6 articles were incorporated,including 4 guidelines,1 expert consensus and 1 clinical practice recommendation. Totally 11 pieces of best evidence were summarized,including body position,zero position,the amount of saline instillation,timing and frequency of measurement,and the using of sedative and analgesic programs. Conclusion This evidence summary can provide a reference for the monitoring and management of intra-abdominal pressure via bladder in critically ill patients. It can also help to standardize the method of intra-abdominal pressure monitoring via bladder and improve the accuracy of the monitoring results. Specific clinical background and patient’s preferences should also be considered before application,so as to improve the accuracy of the monitoring and management of intra-abdominal pressure via bladder,and improve the nursing quality.

Key words: Critically Ill Patients, Intra-Abdominal Pressure, Monitoring and Management, Evidence-Based Nursing

王晓瑾, 黄春荣, 赵慧慧, 黄月华, 蔡敏, 庄水冰, 莫红平. 重症患者经膀胱腹内压监测管理的证据总结[J]. 中华护理杂志, 2022, 57(15): 1886-1892.

WANG Xiaojin, HUANG Chunrong, ZHAO Huihui, HUANG Yuehua, CAI Min, ZHUANG Shuibing, MO Hongping. Evidence summary for monitoring and management of intra-abdominal pressure via bladder in critically ill patients[J]. Chinese Journal of Nursing, 2022, 57(15): 1886-1892.

图/表 4

图1 文献筛选流程

Figure 1 Screening process of studies

表1 纳入文献的基本特征（n=6）

Table 1 Characteristics of the included literature（n=6）

表2 纳入指南的方法学质量评价结果

Table 2 The quality evaluation results of the guidelines

表3 Best evidence summary for monitoring and management of intra-abdominal pressure via bladder in critically ill patients

Table 3 The list of primers

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