慢性伤口氧疗法应用时机与管理策略的最佳证据总结

doi:10.3761/j.issn.0254-1769.2024.19.007

摘要/Abstract

摘要：

目的总结慢性伤口氧疗法应用时机与管理策略的最佳证据，为规范慢性伤口氧疗法实践提供循证依据。方法系统检索BMJ Best Practice、UpToDate、英国国家卫生与临床优化研究所网站、苏格兰校际间指南网、国际指南网、新西兰指南研究组网站、美国国立指南库网站、加拿大安大略省注册护士协会网站、伤口造口失禁专科护士网站、世界伤口愈合协会联合会网站、美国专业伤口处理协会网站、国际伤口感染研究所网站、伤口愈合协会网站、伤口国际网站、澳大利亚伤口管理协会网站、世界造口治疗师协会网站、欧洲血管外科学会网站、伤口发展协会网站、医脉通、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、Cochrane Library、PubMed、Embase、Web of Science、中国知网、万方数据库、维普数据库中有关慢性伤口氧疗法应用时机与管理策略的临床决策、指南、专家共识、证据总结、系统评价或Meta分析，检索时限为2018年10月13日—2023年10月13日，2名研究者对纳入文献进行质量评价、提取数据和整合证据。结果共纳入28篇文献，包括6篇指南、4篇专家共识、3篇证据总结、15篇系统评价。总结了包括高压氧适应证、禁忌证、应用时机、评估、管理策略、有效性和不良反应7个方面的18条证据；局部氧疗适应证、应用时机、评估、管理策略、有效性和不良反应6个方面的12条证据。结论氧疗法可用于慢性伤口管理的辅助治疗，临床实践者应充分评估氧疗法的应用范围和应用时机，并基于具体的临床情境，考虑证据的可行性、适宜性、临床意义与有效性，并结合患者的偏好进行证据应用，促进慢性伤口愈合。

关键词: 慢性伤口, 氧疗, 高压氧, 局部氧疗, 管理策略, 证据总结, 循证护理学

Abstract:

Objective To summarize the most robust evidence on application timing and management strategies for chronic wound oxygen therapy and to provide an evidence-based basis for standardizing clinical practice. Methods A systematic literature search of BMJ Best Practice， UpToDate， NICE， SIGN， GIN， NZGG， NGC， RNAO， WOCN， WUWHS， APWCA， IWII， WHS， WI， AWMA， WCET， ESVS， AAWC， Medlive， JBI， Cochrane Library， PubMed， Embase， Web of Science， CNKI， Wanfang and VIP was conducted to collect the literature including clinical decision resources，guidelines，expert consensuses，evidence summaries，systematic reviews，and meta-analyses related to the application timing and management strategies for chronic wound oxygen therapy. The search period spanned from October 13，2018，to October 13，2023. There were 2 researchers who assessed the quality of the included literature，extracted relevant data，and synthesized the evidence. Results In total，we included 28 pieces of literature，consisting of 6 guidelines，4 expert consensus papers，3 evidence summaries，and 15 systematic reviews. From these sources，we distilled 18 pieces of evidence including 7 aspects of indications, contraindications，application timing, assessment，management strategies，effectiveness，and adverse reactions of hyperbaric oxygen therapy；12 pieces of evidence from 6 aspects of indications, application time, assessment, management strategies, effectiveness, and adverse reactions of local oxygen therapy. Conclusion Oxygen therapy can be used as an adjunct therapy for chronic wound management. Clinical practitioners should fully evaluate the scope and timing of the application of oxygen therapy，consider the feasibility，suitability，clinical significance，and effectiveness of evidence based on the specific clinical situations，and apply evidence in combination with patient preferences to promote chronic wound healing.

Key words: Chronic Wound, Oxygen Therapy, Hyperbaric Oxygen Therapy, Topical Oxygen Therapy, Management Strategy, Summary of Evidence, Evidence-Based Nursing

罗家音, 张小艳, 陈闪闪, 段煜, 郭张慧, 孙超. 慢性伤口氧疗法应用时机与管理策略的最佳证据总结[J]. 中华护理杂志, 2024, 59(19): 2353-2361.

LUO Jiayin, ZHANG Xiaoyan, CHEN Shanshan, DUAN Yu, GUO Zhanghui, SUN Chao. Best evidence summary of application timing and management strategies for chronic wound oxygen therapy[J]. Chinese Journal of Nursing, 2024, 59(19): 2353-2361.

图/表 5

表1 PubMed检索策略

Table 1 Search strategies of PubMed database

图1 文献筛选流程

Figure 1 Flow diagram of study screening process

表2 纳入文献的基本特征（n=28）

Table 2 Characteristics of included studies（n=28）

表3 慢性伤口高压氧治疗的最佳证据总结

Table 3 Summary of best evidence on hyperbaric oxygen therapy in chronic wounds

表4 慢性伤口局部氧疗的最佳证据总结

Table 4 Summary of best evidence on topical oxygen therapy in chronic wounds

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