重症患者腹内高压预防与管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.17.019

摘要/Abstract

摘要：

目的检索、评价并总结重症患者腹内高压的相关证据,为临床护理人员预防和管理重症患者腹内高压提供参考依据。方法系统检索UpToDate、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、加拿大安大略护士协会网站、苏格兰院际间指南网、乔安娜布里格斯研究所循证卫生保健中心数据库、WHO官网、中国医脉通指南网、世界腹腔间隔室综合征学会网站、Cochrane Library、PubMed、Embase、CINAHL、中国知网、万方数据库等,关于重症患者腹内高压的证据,包括指南、推荐实践、证据总结、专家共识、系统评价、随机对照试验、最佳实践信息手册等,检索时限为建库至2021年12月。由2名研究者独立进行文献质量评价和资料提取。结果共纳入证据15篇,包括指南5篇、专家推荐1篇、专家共识2篇、最佳实践1篇、系统评价6篇,汇总、提取21条最佳证据,包括评估、监测管理、治疗管理、体位管理、肠内营养管理、容量复苏和液体管理6类。结论该研究总结的重症患者腹内高压预防和管理的最佳证据具有科学性和全面性,为医护人员规范化监测、管理重症患者腹内高压提供了循证依据。

关键词: 重症患者, 腹内高压, 证据总结, 循证护理学

Abstract:

Objectives To retrieve,evaluate and summarize the best evidence for preventing and management of intra-abdominal hypertension in critically ill patients to provide evidence for clinical nurses to prevent and monitor the intra-abdominal hypertension in critically ill patients. Methods We searched websites and databases including,but not limited to,UpToDate,BMJ Best Practice,National Institute for Health and Clinical Excellence,Guidelines International Network,Registered Nurses Association of Ontario,Scottish Intercollegiate Guidelines Network,World Health Organization,Yimaitong guide network,World Society of the Abdominal Compartment Syndrome （ WSACS ）,Cochrane library,PubMed,Embase （ OVID ）,CINAHL （ EBSCO ）,CNKI,Wanfang for guidelines,recommended practices,evidence summaries,expert consensuses,and systematic reviews,randomized controlled trials,best practice information manuals regarding monitoring and management of intra-abdominal hypertension in critically ill patients were searched and retrieved. 2 researchers independently assessed methodological quality of included papers and extracted data. Results A total of 15 articles were included,including 5 guidelines,1 expert recommendation,2 expert consensuses,1 best recommendation,6 systematic reviews. Finally,21 pieces of best evidence were formed from 6 aspects,namely the assessment,monitoring management,treatment management,posture management,enteral nutrition management,volume resuscitation and fluid management. Conclusion The best evidence for prevention and management of intra-abdominal hypertension in critically ill patients summarized in this study is scientific and comprehensive,providing the evidence-based basis for medical staff to standardized measurement and management of intra-abdominal hypertension in critically ill patients in clinical practice.

Key words: Critically Ill Patients, Intra-Abdominal Hypertension, Evidence Summary, Evidence-Based Nursing

陈丽花, 盛青青, 黄瑶, 张国龙, 覃彦珠, 张清, 黄小群, 黄敬烨. 重症患者腹内高压预防与管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(17): 2164-2170.

CHEN Lihua, SHENG Qingqing, HUANG Yao, ZHANG Guolong, QIN Yanzhu, ZHANG Qing, HUANG Xiaoqun, HUANG Jingye. Summary of best evidence on preventing and management of intra-abdominal hypertension in critically ill patients[J]. Chinese Journal of Nursing, 2022, 57(17): 2164-2170.

图/表 3

表1 纳入文献的一般特征（n=15）

Table 1 Characteristics of included studies（n=15）

表2 指南的质量评价结果（n=5）

Table 2 Study quality assessed by AGREE Ⅱ（n=5）

表3 重症患者腹内高压预防和管理的最佳证据总结

Table 3 Evidence summary of preventing and management of intra-abdominal hypertension for critically ill patients

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