全球现有儿童腹泻临床实践指南的循证评价  

Evidence-based Evaluation of Global Existed Diarrhea Guidelines of Children

作　　者：张扬[1,2,3] 全淑燕[1,2,3] 曾力楠 黄亮[1,2,3] 汪志凌[4] 蒋璐灿 黄宗瑶 张伶俐 ZHANG Yang;QUAN Shuyan;ZENG Linan;HUANG Liang;WANG Zhiling;JIANG Lucan;HUANG Zongyao;ZHANG Lingli(Dept.of Pharmacy,West China Second Hospital,Sichuan University,Chengdu 610041,China;Evidence-based Pharmacy Center,West China Second Hospital,Sichuan University,Chengdu 610041,China;Key Lab of Birth Defects and Related Diseases of Women and Children,Ministry of Education,Chengdu 610041,China;Dept.of Pediatrics,West China Second Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西第二医院药学部,成都610041 [2]四川大学华西第二医院循证药学中心,成都610041 [3]出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [4]四川大学华西第二医院儿科,成都610041

出　　处：《中国药房》2018年第8期1109-1116,共8页China Pharmacy

基　　金：国家自然科学基金资助项目(No.81373381)

摘　　要：目的:评价全球现有儿童腹泻临床实践指南,为临床实践和我国儿童腹泻循证指南的制定提供证据和方法学参考。方法:计算机系统检索Pub Med、Embase、中国生物医学文献数据库、中国知网、维普、万方等数据库及指南相关网站,并补充检索纳入文献的参考文献,检索时限均为建库起至2017年12月,采用指南研究与评价系统Ⅱ(AGREEⅡ)评价指南的方法学质量,由2名研究员独立完成,以组内相关系数(ICC)分析计算不同研究者评价结果的组间差异,并分析比较各指南的异同。结果:初检获得1 168篇相关文献,最终纳入指南15个,其中美国3个,英国2个,世界卫生组织(WHO)2个,意大利、欧洲、印度、澳大利亚、马来西亚、新南威尔士、南非和中国各1个。15个指南中,10个为循证指南,5个为非循证指南,指南证据级别与推荐强度方法不一。两名研究员评价得分ICC>0.75,P<0.05,表明组间评价一致性高。15篇指南总体质量不高,纳入指南在AGREEⅡ各领域得分从高到低依次为:范围与目的(84.44%)、表达的清晰性(79.82%)、参与人员(45.74%)、制定的严谨性(41.18%)、编辑的独立性(36.39%)、应用性33.89%。指南推荐的主要防治方式大体一致:(1)预防和治疗脱水是儿童腹泻病治疗的关键环节;(2)各指南普遍认为补液期间继续母乳喂养可降低患儿脱水风险;(3)推荐锌制剂治疗腹泻以缩短病程;(4)合理使用抗菌药物等。结论:全球现有儿童腹泻指南整体质量有待提高。我国尚无综合全面的儿童腹泻循证指南,且我国目前儿童腹泻治疗现状和WHO标准存在一定差距,需建立规范化治疗方案。建议以AGREEⅡ条目为参考标准,同时结合国际指南报告规范标准,综合考虑我国儿童腹泻疾病负担及发病特征,制定符合我国国情的高质量儿童腹泻循证指南。OBJECTIVE:To evaluate the global existed diarrhea guidelines of children,and provide evidence and methodology reference for clinical practice and the formulation of diarrhea evidence-based guideline of children in China.METHODS:Retrieved from PubMed,Embase,CBM,CNKI,VIP,Wanfang databases and related websites,references included in studies were retrieved additionally from database building to Dec.2017.The methodological quality of the guideline was evaluated by 2 researchers independently with guideline evaluation toolⅡ(AGREEⅡ).ICC analysis was used to calculate the differences between the evaluation results of 2 researchers and analyze the difference of the guidelines.RESULTS:A total of 1 168 literatures were collected primarily,and 15 guidelines were involved finally,among which 3 guidelines were from USA,2 from British,2 from WHO,each one from Italy,Europe,India,Australia,Malaysia,New South Wales,South Africa and China,respectively.Of 15 guidelines,there were 10 evidence-based guidelines and 5 non-evidence-based guidelines;evidence levels of guidelines and the method of recommendation intensity were different.ICC of 2 researchers were higher than 0.75(P<0.05),indicating good homogeneity among them.The quality of 15 guidelines were not high enough,and the scores of included guidelines in the field of AGREEⅡin descending order were as follows:scope and purpose(84.44%),clarity of presentation(79.82%),stakeholder involvement(45.74%),rigor of development(41.18%),editorial independence(36.39%)and applicability(33.89%).Main prevention and treatment method recommended by guideline included that(1)prevention and treatment of dehydration was the key link in the treatment of children’s diarrhea;(2)guidelines generally believed continuous breastfeeding during rehydration could reduce the risk of dehydration in children;(3)zinc preparation was recommended to shorten the course of diarrhea;(4)antibiotics were used rationally,etc.CONCLUSIONS:The quality of global existed diarrhea guidelines of children should be improv

关 键 词：儿童腹泻 儿童急性胃肠炎 临床实践指南 指南研究与评价系统Ⅱ 循证评价 

分 类 号：R452[医药卫生—治疗学] R720.5[医药卫生—临床医学]