基于GRADE系统的急诊PCI患者术前皮肤准备随机对照试验的  

An evaluation study on the randomized controlled trial of preoperative skin preparation for emergency percutaneous coronary intervention based on GRADE system

作　　者：秦培培 罗旭飞 郝云霞 武杰 刘周周 张妍 张艳娟 庞冉 赵蕊 刘焱 赵冬云 孙羽 李庆印 Qin Peipei;Luo Xufei;Hao Yunxia;Wu Jie;Liu Zhouzhou;Zhang Yan;Zhang Yanjuan;Pang Ran;Zhao Rui;Liu Yan;Zhao Dongyun;Sun Yu;Li Qingyin(Nursing Department,Fuwai Hospital of Chinese Academy of Medical Sciences,Beijing 100037,China;Evidence-Based Medicine Center/Chinese GRADE Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China)

机构地区：[1]中国医学科学院阜外医院护理部,北京100037 [2]兰州大学循证医学中心/GRADE中国中心,兰州大学基础医学院,730000

出　　处：《中华现代护理杂志》2018年第33期3975-3979,共5页Chinese Journal of Modern Nursing

基　　金：2017协和青年科研基金(2017330002);2011年度国家临床重点专科建设项目单位(卫办医政函[2011]873).

摘　　要：目的通过系统评价和分析急诊PCI患者术前皮肤准备相关随机对照试验(RCT)的证据水平,了解现阶段急诊PCI患者术前皮肤准备RCT的研究现状、证据水平,为急诊PCI患者术前皮肤准备提供参考意见。方法计算机检索PubMed、EMbase、The Cochrane Library、CINAHL、JBI,以及中国生物医学文献数据库(CBM)、CNKI、万方数据知识服务平台(Wanfang Data)中有关急诊PCI患者术前皮肤准备的RCT。检索时间为建库至2018年3月。由2名证据小组成员按照纳入、排除标准独立进行文献筛选和资料提取,并对纳入的文献进行方法学质量评价。利用Review Manger 5.3软件对相关结局指标进行Meta分析,使用GRADE Profiler 3.6.1软件进行GRADE分级。结果最终共纳入5篇RCT,其中文献质量等级为A级的RCT数量为1篇,质量等级为B级的RCT数量为4篇。Meta分析结果显示,急诊PCI患者术前采用传统方法常规去除手术野毛发和不去除毛发的方式备皮,两者在降低术后穿刺点皮肤感染发生率上差异无统计学意义(P>0.05)。另外,术前常规去除毛发可能会造成术前准备时间延长,且可能对患者造成心理不适。经过GRADE系统评级,证据体的质量为低等级别。结论行急诊PCI患者术前常规不去除穿刺处及周围的全部毛发更有利于缩短救治时间。纳入的证据尚不能确定不完全去除毛发是否能够降低感染率,今后应开展更多规范严谨的大样本、多中心、高质量的研究,为本研究提供更加可信的证据支持。Objective To systematically evaluate and analyze the evidence level of randomized controlled trials (RCT) of preoperative skin preparation for emergency percutaneous coronary intervention (PCI) , and to understand the current research status and evidence level of preoperative skin preparation randomized controlled trials for emergency PCI, and provide reference for skin preparation for emergency PCI. Methods PubMed, EMbase, The Cochrane Library, CINAHL, JBI, CBM, CNKI, Wanfang DATA were searched by computer from inception to March, 2018 for emergency PCI preoperative skin preparation randomized controlled trials. Two evidence panel members searched and selected articles independently and the quality was assessed in accordance with Cochrane Manual. The articles were analyzed with Review Manager 5.3, and the evidence quality was assessed with GRADE profiler 3.6.1 software. Results A total of 5 RCTs were included, of which the number of RCTs with grade A quality was 1 and the number of RCTs with grade B was 4. The results of the Meta analysis showed that there was no significant difference in the incidence of skin infections at the postoperative puncture site by conventional methods for routine removal of surgical wild hair and no removal of hair prior to emergency PCI (P<0.05) . In addition, regular removal of hair before surgery may result in prolonged preoperative preparation and may cause psychological discomfort to the patient. After the GRADE system rating, the quality of the evidence body was of a lower level. Conclusions It is more beneficial to shorten the treatment time without routine removal of all the hair at the puncture site and the surrounding patients. The evidence included is not yet certain whether the incomplete removal of hair can reduce the infection rate. In the future, more large-scale, multi-center, high-quality research should be carried out to provide more credible evidence for this study.

关 键 词：手术前护理 急诊PCI 皮肤准备 GRADE系统 证据评价 

分 类 号：R473.5[医药卫生—护理学]