连续性肾脏替代治疗患者中心静脉导管相关血栓预防的最佳证据总结

doi:10.3761/j.issn.2096-7446.2024.05.015

摘要/Abstract

摘要： 目的检索、评估和整合关于连续性肾脏替代治疗（continuous renal replacement therapy,CRRT）患者中心静脉导管相关血栓（catheter-related thrombosis,CRT）预防的最佳证据。方法计算机检索BMJ Best Practice、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、国际指南协作网、英国国家卫生与临床优化研究所、苏格兰校际指南网、美国肾脏病基金会等专业相关网站,以及PubMed、Embase、中国知网、万方数据库、中国生物医学文献数据库、医脉通中与CRRT患者中心静脉CRT预防有关的临床决策、指南、最佳实践、证据总结、系统评价、专家共识。检索时限为建库至2023年3月。由2名循证团队成员进行文献筛选、质量评价及证据提取与汇总。结果共纳入12篇文献,分别为3篇临床决策、4篇指南、2篇系统评价和3篇专家共识。从8个方面汇总形成27条最佳证据,包括评估、穿刺及拔管、导管类型、血管通路监测方法、封管、抗凝剂、溶栓治疗、培训和管理。结论医护人员在实施CRRT患者中心静脉CRT预防时,应结合临床具体情境与患者意愿,审慎地选择最佳证据,增强治疗效果和安全性,以促进患者获益最大化。

关键词: 连续性肾脏替代治疗, 导管相关血栓, 预防, 证据总结, 循证护理学

Abstract: Objective To retrieve,evaluate,and integrate the best evidence for the prevention and management of central venous catheter-related thrombosis（CRT） in patients with continuous renal replacement therapy（CRRT）. Methods We searched BMJ Best Practice,UpToDate and Cochrane Library,Australian Joanna Briggs Institute Evidence-Based Health Care Center database,International Guide Network,UK Institute for Health and Care Excellence,Scottish Interuniversity Guide Network,American Kidney Disease Foundation and other professional related websites,PubMed,Embase,CNKI,Wanfang Database,China Biology Medicine disc,Medlive to collect clinical decisions,guidelines,best practices,expert consensus,systematic review,summary of evidence,and original research related to central venous CRT prevention in CRRT patients. The retrieval period was from the establishment of the database to March 2023. Literature selection,quality evaluation and data extraction were conducted by two members of the evidence-based team. Results A total of 12 literatures were included,including 3 clinical decisions,4 guidelines,2 systematic reviews and 3 expert consensuses. 27 best pieces of best evidence were summarized in 8 aspects,including assessment,cannulation and extubation,catheter type,vascular access monitoring methods,tube sealing,anticoagulants,thrombolysis,training and management. Conclusion In the clinical prevention practice of central venous CRT for CRRT patients,ICU medical staff should carefully select the best evidence to enhance treatment efficacy and safety based on the specific clinical context and the patient‘s wishes,so as to maximize the benefits of patients.

Key words: Continuous Renal Replacement Therapy, Catheter-Related Thrombosis, Prevention, Evidence Summary, Evidence-Based Nursing

李莉莉, 华佳丽, 张馨尹, 董永泽, 宋昱莹, 陈娟英, 姚惠萍. 连续性肾脏替代治疗患者中心静脉导管相关血栓预防的最佳证据总结[J]. 中华急危重症护理杂志, 2024, 5(5): 466-473.

LI Lili, HUA Jiali, ZHANG Xinyin, DONG Yongze, SONG Yuying, CHEN Juanying, YAO Huiping. Summary of the best evidence for the prevention and management of central venous catheter-related thrombosis in patients undergoing continuous renal replacement therapy[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(5): 466-473.

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