静脉-动脉体外膜肺氧合患者下肢缺血预防和管理的最佳证据总结  

Best evidence summary of prevention and management of lower limb ischemia in patients with veno-arterial extracorporeal membrane oxygenation

作　　者：陈丽花[1] 王新宁 王晶 何婷婷 黄瑶 盛青青 谭玉凤 张书琴 黄小群[1] 徐蒙蒙[1] 桑岭[1] 张洁[1] 徐永昊[1] Chen Lihua;Wang Xinning;Wang Jing;He Tingting;Huang Yao;Sheng Qingqing;Tan Yufeng;Zhang Shuqin;Huang Xiaoqun;Xu Mengmeng;Sang Ling;Zhang Jie;Xu Yonghao(Department of Critical Care Medicine,First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510230,Guangdong,China;School of Nursing,Guangzhou Medical University,Guangzhou 510182,Guangdong,China)

机构地区：[1]广州医科大学附属第一医院重症医学科,广东广州510230 [2]广州医科大学护理学院,广东广州510182

出　　处：《中华危重病急救医学》2024年第11期1190-1195,共6页Chinese Critical Care Medicine

基　　金：广东省医学科研基金项目(A2023440);广东省中医药局科研项目(20221240)。

摘　　要：目的检索、评价和总结静脉-动脉体外膜肺氧合(VA-ECMO)患者下肢缺血预防和管理的相关证据,为VA-ECMO患者治疗期间下肢缺血的预防和管理提供循证依据。方法基于PIPOST(目标人群、干预措施、实施者、结局、应用场所、证据类型)提出循证问题,按照"6S"证据金字塔模型系统检索国内外数据库、专业协会网站中有关VA-ECMO患者(年龄≥18岁)下肢缺血预防和管理的相关证据(包括临床决策、指南、专家共识、系统评价、证据总结和原始研究),检索时限从建库至2024年2月。由2名研究者独立进行文献质量评价,对符合质量标准的文献进行证据提取及总结。结果最终纳入13篇文献,包括3篇临床决策、3篇指南、3篇专家共识、3篇系统评价和1篇随机对照试验。总结出包括VA-ECMO下肢缺血的危险因素、置管前评估、治疗期间的评估与监测、下肢缺血的预防、下肢缺血的治疗措施、远端灌注导管(DPC)的管理、以及VA-ECMO撤离后监测等7个维度的18条证据。结论该证据总结为VA-ECMO患者下肢缺血预防和管理提供了循证依据,建议结合VA-ECMO支持治疗的临床实际条件制定针对性的方案进行合理的下肢缺血预防及管理。Objective To provide evidence-based recommendations for the prevention and management of lower limb ischemia in veno-arterial extracorporeal membrane oxygenation(VA-ECMO)patients during treatment according to search,evaluate,and summarize the best evidence on the prevention and management of lower limb ischemia in patients with VA-ECMO.Methods Based on the PIPOST framework(population,intervention,professional,outcome,setting,and type of evidence),an evidence-based question was formulated.A systematic search was conducted according to the"6S"evidence pyramid model in both domestic and international databases,as well as professional association websites,for all evidence related to the prevention and management of lower limb ischemia in VA-ECMO patients(aged≥18 years).The types of evidence included clinical decisions,guidelines,expert consensus,systematic reviews,evidence summaries,and original studies.The search was conducted from the construction of the databases to February 2024.Two researchers independently conducted a literature quality evaluation,extracted and summarized evidence from the studies that met the quality criteria.Results A total of 13 articles were included,consisting of 3 clinical decisions,3 guidelines,3 expert consensus,3 systematic reviews,and 1 randomized controlled trial.A total of 18 pieces of evidence in 7 dimensions were summarized,including risk factors of VA-ECMO lower limb ischemia,evaluation before catheterization,evaluation and monitoring during treatment,prevention of lower limb ischemia,treatment of lower limb ischemia,management of distal perfusion catheter(DPC),and monitoring after VA-ECMO weaning.Conclusion This evidence summary provides evidence-based recommendations for the prevention and management of lower limb ischemia in VA-ECMO patients,aiming to assist clinical healthcare professionals in developing tailored strategies for the prevention and management of lower limb ischemia based on during VA-ECMO support.

关 键 词：体外膜肺氧合 下肢缺血 证据总结 循证护理 

分 类 号：R473[医药卫生—护理学]