成人颅脑损伤患者神经源性肠道功能障碍管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.11.015

摘要/Abstract

摘要：

目的总结颅脑损伤患者神经源性肠道功能障碍管理的最佳证据，为临床护理实践提供参考依据。方法系统检索计算机决策系统、指南网站、专业协会网站、循证数据库和综合数据库中关于颅脑损伤患者神经源性肠道功能障碍管理的相关证据，检索时限为建库至2022年10月1日。纳入证据类型包括临床决策、指南、证据总结、最佳实践、推荐实践、专家共识、系统评价和Meta分析。由2名经过循证方法学系统培训的研究者独立进行文献质量评价，并对纳入文献进行证据提取、整合和证据分级。结果共纳入18篇文献，包括指南4篇、专家共识3篇、证据总结1篇、推荐实践1篇、系统评价9篇，文献整体质量较高。从评估及干预时机、行为干预、饮食管理、辅助排便、经肛门灌洗、药物干预、电磁刺激干预、并发症防治和健康教育9个方面，总结出38条证据。结论该研究总结了成人颅脑损伤患者神经源性肠道功能障碍管理的最佳证据，为临床护理实践提供了参考依据。临床工作中应合理选择最佳证据进行本土化、个体化应用，并不断更新最佳证据，规范护理实践。

关键词: 颅脑损伤, 神经源性肠道功能障碍, 证据总结, 循证护理学

Abstract:

Objective To summarize the best evidence on the management of neurogenic bowel dysfunction in adults with brain injury and to provide a reference for clinical care practice. Methods A systematic search of evidence on the management of neurogenic bowel dysfunction in patients with brain injury was conducted in computerized decision systems，guideline websites，professional association websites，and comprehensive databases from the establishment of databases to October 1，2022. Types of included evidence included clinical decision making，guidelines，evidence summaries，best practices，recommended practices，expert consensuses，systematic reviews，and Meta-analysis. The literature was independently evaluated by 2 experts trained in evidence-based methodological systems for the quality of the literature，and the evidence of the included literature was extracted，integrated and graded. Results A total of 18 papers were included，including 4 guidelines，3 expert consensus articles，1 evidence summary，1 recommended practice article，and 9 systematic reviews，and the overall quality of the literature was high. 38 pieces of evidence were summarized in 9 areas：assessment and timing of intervention，behavioral intervention，dietary management，assisted defecation，transanal irrigation，pharmacological intervention，electromagnetic stimulation intervention，complication prevention and control，and health education. Conclusions This study summarized the latest best evidence for the management of neurogenic bowel dysfunction in adults with brain injury，and provided a reference basis for clinical nursing practice. The best evidence should be reasonably selected for localized and individualized application in clinical practice，and the best evidence should be continuously updated to standardize nursing practice.

Key words: Brain Injury, Neurogenic Bowel Dysfunction, Evidence Summary, Evidence-Based Nursing

高艺恬, 周婉琼, 田静, 刘婧, 汪秋伊, 张薇, 陈雪梅, 周兰姝. 成人颅脑损伤患者神经源性肠道功能障碍管理的最佳证据总结[J]. 中华护理杂志, 2023, 58(11): 1372-1380.

GAO Yitian, ZHOU Wanqiong, TIAN Jing, LIU Jing, WANG Qiuyi, ZHANG Wei, CHEN Xuemei, ZHOU Lanshu. Best evidence summary for neurogenic bowel dysfunction management in adults with brain injury[J]. Chinese Journal of Nursing, 2023, 58(11): 1372-1380.

图/表 6

图1 中国知网文献检索策略

Figure 1 Literature search strategy of China National Knowledge Internet

图2 PubMed文献检索策略

Figure 2 Literature search strategy of PubMed

表1 纳入文献的一般特征（n=18）

Table 1 Characteristics of include articles（n=18）

图3 文献筛选流程图

Figure 3 Literature screening process

表2 指南的方法学质量评价结果（n=4）

Table 2 Quality evaluation results of guidelines（n=4）

表3 颅脑损伤患者神经源性肠道功能障碍管理的最佳证据总结

Table 3 Evidence summary for neurogenic bowel dysfunction management in adults with brain injury

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