糖尿病足溃疡复发相关预防措施的系统评价再评价  

Preventive measures for recurrence of diabetic foot ulcer:an overview of systematic reviews

作　　者：万星宇 夏磊 庄若[3] 朱丽群[3] 眭升[3] 梁臣 张炜[3] Wan Xingyu;Xia Lei;Zhuang Ruo;Zhu Liqun;Sui Sheng;Liang Chen;Zhang Wei(Blood Purification Center,Affliated Hospital of Jiangsu University,Zhenjiang 212001,China;Child Healthcare Department,Nanjing Women and Childrens Healthcare Hospital,Nanjing 210000,China;Nursing Department,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China;School of Medicine,Jiangsu University,Zhenjiang 212013,China)

机构地区：[1]江苏大学附属医院血液净化中心,镇江212001 [2]南京市妇幼保健医院儿童保健科,南京210000 [3]江苏大学附属医院护理部,镇江212001 [4]江苏大学医学院,镇江212013

出　　处：《中华现代护理杂志》2024年第27期3647-3657,共11页Chinese Journal of Modern Nursing

基　　金：江苏省老年健康科研项目(LK2021026)。

摘　　要：目的对预防糖尿病足溃疡(DFU)患者复发相关干预措施进行系统评价的再评价。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库、澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心数据库、Cochrane Library、PubMed、Embase、CINAHL、Web of Science等数据库中关于预防DFU复发相关干预措施的系统评价或Meta分析。检索时限均为建库至2023年4月20日。由2名研究者独立检索、筛选文献和提取资料, 使用AMSTAR 2软件及澳大利亚JBI循证卫生保健中心系统评价方法学质量评价标准对纳入文献进行方法学质量评价, 采用GRADE评价系统对结局指标(DFU复发率、预防DFU复发相关措施的有效性)进行质量评价。结果共纳入24篇系统评价, 纳入研究表明足部皮温监测及干预、治疗鞋或鞋垫、综合干预措施及某些特定手术方式可降低DFU复发率, 而足部自我护理、足部相关运动、健康教育及心理干预对预防DFU复发效果不明显。纳入系统评价的方法学质量普遍较低。4篇文献的报告相对完整、18篇文献报告有一定缺陷、2篇文献报告有相对严重的缺陷。对证据质量进行评价显示, 中等质量证据3条、低质量证据7条、极低质量证据30条。结论现有证据表明, 足部皮温监测及干预、治疗鞋或鞋垫、综合干预措施及某些特定手术方式(如跟腱延长术、跖趾关节置换术、跖骨头切除术等)对预防DFU复发有积极影响。此外, 对尚存争议的问题, 今后仍需设计严谨、高标准的研究来验证, 以期为今后临床应用及相关研究提供可靠证据。Objective To carry out an overview of systematic reviews on interventions to prevent the recurrence of diabetic foot ulcer(DFU)patients.Methods Systematic reviews or Meta-analysis on interventions to prevent DFU recurrence were electronically retrieved from databases such as China National Knowledge Infrastructure,WanFang Data,VIP,China Biology Medicine disc,Joanna Briggs Institute(JBI)Evidence-Based Healthcare Center Database,Cochrane Library,PubMed,Embase,CINAHL and Web of Science.The search period was from database establishment to April 20,2023.Two researchers independently searched and screened literature,and extracted data,and used AMSTAR 2 software and the quality evaluation criteria for systematic review of JBI Evidence-Based Healthcare Center to evaluate the methodological quality of the included literature.GRADE evaluation system was used for quality assessment of outcome indicators(DFU recurrence rate,effectiveness of measures to prevent DFU recurrence).Results A total of 24 systematic reviews were included.Studies showed that monitoring and intervention of foot skin temperature,therapeutic shoes or insoles,comprehensive intervention measures,and specific surgical methods could reduce the recurrence rate of DFU,while foot self-care,foot exercise,health education,and psychological intervention had no statistical effect on preventing DFU recurrence.The methodological quality of systematic reviews was generally low.The reports of four articles were relatively complete,18 articles had certain defects,and two articles had serious defects.The evaluation of evidence quality showed that there were three pieces of moderatequality evidence,seven pieces of low-quality evidence,and 30 pieces of extremely low-quality evidence.Conclusions Existing evidence suggests that foot skin temperature monitoring and intervention,therapeutic shoes or insoles,comprehensive intervention measures,and specific surgical methods(such as Achilles tendon lengthening,metatarsophalangeal joint replacement,metatarsal head resection and s

关 键 词：糖尿病足 复发 预防 系统评价再评价 META分析 

分 类 号：R473.5[医药卫生—护理学]