胃肠道术后早期拔除尿管的最佳证据总结  

Best evidence summary of early removal of urinary catheter after gastrointestinal surgery

作　　者：朱玉兰 廖敏 罗裕 李徵羽 李卡[3] ZHU Yulan;LIAO Min;LUO Yu;LI Zhiyu;LI Ka(West China School of Nursing,Sichuan University/Gastric Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Gastric Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China School of Nursing,Sichuan University/West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西护理学院/四川大学华西医院胃癌中心,成都610041 [2]四川大学华西医院胃癌中心,成都610041 [3]四川大学华西护理学院/四川大学华西医院,成都610041

出　　处：《中国普外基础与临床杂志》2025年第4期468-475,共8页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川大学与港澳高校种子基金项目(项目编号:2024-19)。

摘　　要：目的筛选当前国内外胃肠道术后患者早期拔除尿管的最佳证据。方法系统检索以下数据库或网站:Up To Date数据库、英国医学杂志最佳临床实践、乔安娜·布里格斯研究所(Jonna Briggs Institute,JBI)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指南库、加拿大安大略注册护士协会网站、苏格兰校际指南协作网、欧洲泌尿外科护士协会网站、Cochrane Library、ClinicalKey、Embase、PubMed、Web of Science、护理与综合保健期刊索引、中国知网、万方和维普,对文献质量进行评价及提取证据。结果共纳入27篇文献,其中临床决策3篇、指南4篇、系统评价18篇、实践建议1篇及专家共识1篇。经过评价后,总结出23条胃肠道术后患者早期拔除尿管决策的证据,归纳为5个方面:置尿管前评估(6条)、机构和人员要求(2条)、缩短尿管留置时间(8条)、膀胱恢复策略(5条)及尿管拔除时机(2条)。采用2014版JBI循证卫生保健系统证据预分级及推荐级别系统(分为1~5级,1级为最高级别,依次降低,5级为最低级别)以及根据JBI推荐分级(A级为强推荐,B级为弱推荐),23条证据中,证据级别1~5级分别有6、8、1、0及8条;在推荐级别A级和B级分别有14和9条。结论本研究筛选出的早期拔除尿管相关的最佳证据质量较高,可用于指导胃肠道术后患者早期拔除尿管的实践。但是我国对此相关研究较少,我国胃肠道手术中应根据具体情况合理参考应用这些最佳证据。Objective To screen the current optimal evidence for early removal of urinary catheters in patients after gastrointestinal surgery both domestically and internationally.Methods We systematically searched the following databases or website,including the UpToDate,the British Medical Journal Best Practice,the Jonna Briggs Institute Evidence-Based Healthcare Center,the Guidelines International Network,the National Institute for Health and Clinical Excellence Guidelines,the Registered Nurses’Association of Ontario,the Scottish Intercollegiate Guidelines Network,the European Association of Urology Nurses,the Cumulative Index to Nursing and Allied Health Literature,the Cochrane Library,ClinicalKey,Embase,PubMed,Web of Science,CNKI,Wanfang,and VIP.The literature was evaluated,and the evidence was extracted and summarized.Results A total of 27 articles were included,including 3 clinical decisions,4 guidelines,18 systematic reviews,1 practice recommendation,and 1 expert consensus.The 23 evidence items were classified into five categories:pre-catheterization assessment(6 items),institutional and personnel requirements(2 items),strategies to shorten catheter indwelling time(8 items),bladder recovery strategies(5 items),and timing of catheter removal(2 items).These items were classified 5 evidence levels ccording to the 2014 JBI Evidence-Based Healthcare System Evidence Pre-Grading and Recommendation Level System:level 1(6 items),level 2(8 items),level 3(1 item),level 4(0 items),and level 5(8 items).Recommendation grades:grade A(strong recommendation,14 items)and grade B(weak recommendation,9 items).Conclusions The high-quality evidence identified in this study regarding early urinary catheter removal can be effectively applied in the clinical management of patients after gastrointestinal surgery.However,there are few studies on this in China.These best evidence should be adaptively implemented according to the specific situation after gastrointestinal surgery in China.

关 键 词：胃肠道手术 早期拔除尿管 证据总结 

分 类 号：R473.6[医药卫生—护理学]