造血干细胞移植并发移植物抗宿主病患者皮肤护理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.09.014

摘要/Abstract

摘要：

目的检索、评价并整合国内外关于造血干细胞移植并发移植物抗宿主病患者皮肤护理的相关证据。方法根据“6S”模型，系统检索国内外计算机决策支持系统、指南网、相关专业学会或机构网站、综合数据库，筛选与造血干细胞移植并发移植物抗宿主病患者皮肤护理相关的文献，包括指南、临床决策、证据总结、系统评价、专家共识，检索时限为建库到2022年5月。由6名研究人员对文献进行质量评价、证据提取及整合。结果共纳入15篇文献，其中临床决策2篇、指南6篇、专家共识5篇、系统评价2篇。从多学科合作、皮肤评估、护理措施、健康教育4个方面汇总13条最佳证据。结论该研究系统整合了造血干细胞移植并发移植物抗宿主病患者皮肤护理的相关证据，可为相关指南和临床实践规范的制订提供循证依据。在应用证据时，建议护理人员综合考虑临床实际情况及患者意愿，审慎地选择证据。

关键词: 造血干细胞移植, 移植物抗宿主病, 皮肤护理, 循证护理学

Abstract:

Objective To search，evaluate and integrate relevant evidence of skin care for patients with hematopoietic stem cell transplantation complicated by graft-versus-host disease（GVHD）. Methods Based on the “6S” pyramid model，the evidence was systematically searched in computer decision support systems，websites of guidelines，relevant professional associations and organizations and comprehensive databases，and evidence of skin care for patients with hematopoietic stem cell transplantation complicated by GVHD were screened from the establishment of databases to May 2022，including guidelines，clinical decisions，evidence summaries，systematic reviews，and expert consensuses. The quality evaluation，evidence extraction and integration of the evidence were conducted by 6 research members. Results A total of 15 pieces of literature were included，including 2 clinical decisions，6 guidelines，5 expert consensuses and 2 systematic reviews. 13 pieces of best evidence were summarized from 4 aspects，including multidisciplinary cooperation，skin assessment，nursing interventions and health education. Conclusion This study systematically integrated the relevant evidence of skin care for patients with hematopoietic stem cell transplantation complicated by GVHD，and provided evidence-based references for the development of relevant guidelines and clinical practice standards. When applying the evidence，nurses are recommended to com-prehensively consider the actual clinical situations and patients’ wishes，and select evidences prudently.

Key words: Hematopoietic Stem Cell Transplantation, Graft Versus Host Disease, Skin Care, Evidence-Based Nursing

王利秀, 李建芳, 程红霞, 罗彦, 杨冰香, 刘茜. 造血干细胞移植并发移植物抗宿主病患者皮肤护理的最佳证据总结[J]. 中华护理杂志, 2023, 58(9): 1120-1126.

WANG Lixiu, LI Jianfang, CHENG Hongxia, LUO Yan, YANG Bingxiang, LIU Qian. Best evidence summary for skin care in patients with hematopoietic stem cell transplantation complicated by graft-versus-host disease[J]. Chinese Journal of Nursing, 2023, 58(9): 1120-1126.

图/表 4

图1 文献筛选流程图

Figure 1 Flow chart of literature screening

表1 纳入文献的一般资料（n=15）

Table 1 Information of the included literature（n=15）

表2 纳入指南的质量评价结果（n=6）

Table 2 Quality evaluation of guidelines（n=6）

表3 造血干细胞移植并发移植物抗宿主病患者皮肤护理的最佳证据总结

Table 3 Best evidence summary for skin care in patients with hematopoietic stem cell transplantation complicated by graft-versus-host disease

参考文献 32

[1]	Ferrara JL, Levine JE, Reddy P, et al. Graft-versus-host disease[J]. Lancet, 2009, 373(9674):1550-1561. DOI PMID
[2]	Rodrigues KS, Oliveira-Ribeiro C, de Abreu Fiuza Gomes S, et al. Cutaneous graft-versus-host disease:diagnosis and treatment[J]. Am J Clin Dermatol, 2018, 19(1):33-50. DOI PMID
[3]	Campbell J, Gavin N, Button E, et al. Skin and wound care for individuals with graft versus host disease:a scoping review protocol[J]. BMJ Open, 2020, 10(10):e038567. DOI URL
[4]	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
[5]	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ:advan-cing guideline development,reporting and evaluation in health care[J]. J Clin Epidemiol, 2010, 63(12):1308-1311. DOI PMID
[6]	Joanna Briggs Institute. Joanna Briggs Institute reviews’ manual: 2016 edition[EB/OL]. (2016)[2023-01-06]. https://www.joanna briggs.org.
[7]	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.
[8]	Cowen EW. Cutaneous manifestations of graft-versus-host disease[EB/OL]. (2022-12-02)[2023-01-06]. https://www.uptodate.com/contents/cutaneous-manifestations-of-graft-versus-host-disea-se-gvhdsearch=Cutaneous%20manifestations%20of%20graft-versus-host%20disease&source=search_result&selectedTitle=1-150&usage_type=default&display_rank=1.
[9]	Zeiser R. Treatment of chronic graft-versus-host disease[EB/OL]. (2022-03-07)[2023-01-06]. https://www.uptodate.com/contents/treatment-of-chronic-graft-versus-host-disease?search=T%20Treatment%20of%20chronic%20graft-versus-host%20disease&source=search_result&selectedTitle=1-150&usage_type=default&display_rank=1.
[10]	National Comprehensive Cancer Network. Graft-versus-host disease[EB/OL]. (2021)[2023-01-06]. https://www.nccn.org/patients/guidelines/content/PDF/GVDH-patient-guideline.pdf.
[11]	Schoemans HM, Lee SJ, Ferrara JL, et al. EBMT-NIH-CIBMTR Task Force position statement on standardized terminology & guidance for graft-versus-host disease assessment[J]. Bone Marrow Transplant, 2018, 53(11):1401-1415. DOI
[12]	Peniket DA. Guidelines for diagnosis and management of cutaneous graft-versus-host disease[EB/OL]. (2017-02)[2023-01-06]. https://nssg.oxford-haematology.org.uk/.
[13]	Dignan FL, Clark A, Amrolia P, et al. Diagnosis and management of acute graft-versus-host disease[J]. Br J Haematol, 2012, 158(1):30-45. DOI URL
[14]	Dignan FL, Amrolia P, Clark A, et al. Diagnosis and management of chronic graft-versus-host disease[J]. Br J Haematol, 2012, 158(1):46-61. DOI URL
[15]	Dignan FL, Scarisbrick JJ, Cornish J, et al. Organ-specific management and supportive care in chronic graft-versus-host disease[J]. Br J Haematol, 2012, 158(1):62-78. DOI URL
[16]	Kitko CL, Pidala J, Schoemans HM, et al. National institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease:Ⅱa. The 2020 clinical implementation and early diagnosis working group report[J]. Transplant Cell Ther, 2021, 27(7):545-557. DOI URL
[17]	Penack O, Marchetti M, Ruutu T, et al. Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies:updated consensus recommendations of the European Society for Blood and Marrow Transplantation[J]. Lancet Haematol, 2020, 7(2):e157-e167. DOI PMID
[18]	Jagasia MH, Greinix HT, Arora M, et al. National institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease:Ⅰ. The 2014 diagnosis and staging working group report[J]. Biol Blood Marrow Transplant, 2015, 21(3):389-401. DOI URL
[19]	Carpenter PA, Kitko CL, Elad S, et al. National institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease:Ⅴ. the 2014 ancillary therapy and supportive care working group report[J]. Biol Blood Marrow Transplant, 2015, 21(7):1167-1187. DOI URL
[20]	Lee SJ, Wolff D, Kitko C, et al. Measuring therapeutic response in chronic graft-versus-host disease. National institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease:Ⅳ. The 2014 response criteria working group report[J]. Biol Blood Marrow Transplant, 2015, 21(6):984-999. DOI URL
[21]	Rambhia PH, Conic RZ, Atanaskova-Mesinkovska N, et al. Role of graft-versus-host disease in the development of secondary skin cancers in hematopoietic stem cell transplant recipients:a Meta-analysis[J]. J Am Acad Dermatol, 2018, 79(2):378-380.e3. DOI PMID
[22]	DePry JL, Vyas R, Lazarus HM, et al. Cutaneous malignant neoplasms in hematopoietic cell transplant recipients:a systematic review[J]. JAMA Dermatol, 2015, 151(7):775-782. DOI URL
[23]	Vaidya T, Menzer C, Ponce DM, et al. Inpatient management of mucocutaneous GVHD[J]. Curr Dermatol Rep, 2019, 8(4):258-278.
[24]	Matin RN, Danby R, Gibbons E, et al. Developing a dedicated dermatology service for allogeneic bone marrow transplant recipients[J]. Br J Dermatol, 2017, 177(6):1758-1759. DOI PMID
[25]	Hillen U, Häusermann P, Massi D, et al. Consensus on perform-ing skin biopsies,laboratory workup,evaluation of tissue samples and reporting of the results in patients with suspected cutaneous graft-versus-host disease[J]. J Eur Acad Dermatol Venereol, 2015, 29(5):948-954. DOI PMID
[26]	Matziou V, Vlahioti E, Perdikaris P, et al. Physician and nursing perceptions concerning interprofessional communication and collaboration[J]. J Interprof Care, 2014, 28(6):526-533. DOI PMID
[27]	卢芳燕, 汤洒潇, 王燕, 等. 活体小肠移植受者多学科协作护理方案的制订及应用[J]. 中华护理杂志, 2021, 56(2):218-224. DOI
	Lu FY, Tang SX, Wang Y, et al. Development and application of a multidisciplinary nursing program for recipients of living small bowel transplantation[J]. Chin J Nurs, 2021, 56(2):218-224. DOI
[28]	Jacobsohn DA, Kurland BF, Pidala J, et al. Correlation between NIH composite skin score,patient-reported skin score,and out-come:results from the chronic GVHD consortium[J]. Blood, 2012, 120(13):2545-2552. DOI PMID
[29]	颜霞, 徐晓东, 侯悦, 等. 4例异基因造血干细胞移植患者急性移植物抗宿主病重度皮肤损伤的护理[J]. 中华护理杂志, 2006, 41(1):38-40.
	Yan X, Xu XD, Hou Y, et al. Nursing care of 4 patients with acute graft-versus-host disease involving severe skin lesions following allogeneic hematopoietic stem cell transplantation[J]. Chin J Nur, 2006, 41(1):38-40.
[30]	颜霞, 孙慧, 徐晓东, 等. 120例HLA单倍体造血干细胞移植后急性移植物抗宿主病患者的护理[J]. 中华护理杂志, 2007, 42(8):701-703.
	Yan X, Sun H, Xu XD, et al. Nursing care of 120 patients with acute graft-versus-host disease receiving HLA-mismatched hematopoietic stem cell transplantation[J]. Chin J Nurs, 2007, 42(8):701-703.
[31]	Goldstein BG, Goldstein AO. Topical corticosteroids:use and adverse effects[EB/OL]. (2022-09-13)[2023-01-06]. https://www.uptodate.com/contents/topical-corticosteroids-use-and-adverse-effects?search=Topical%20corticosteroids:%20Use%20and%20adverse%20effects&source=search_result&selectedTitle=1-150&usage_type=default&display_rank=1.
[32]	Saavedra C, Cheng H. Patient concerns about topical corticosteroids and impact on adherence[J]. Australas J Dermatol, 2021, 62(3):419-421. DOI PMID