无肝素连续性肾脏替代治疗体外循环凝血预防及管理的最佳证据总结

doi:10.16460/j.issn1008-9969.2022.10.054

摘要/Abstract

摘要： 目的总结无肝素连续性肾脏替代治疗（continuous renal replacement therapy, CRRT）体外循环凝血预防及管理的最佳证据,为临床护理工作提供参考。方法根据循证护理的方法确定问题,检索澳大利亚JBI循证卫生保健中心、国际指南协作网等指南网站,中国知网、PubMed等中英文数据库以及国际肾脏病学会和中华医学会肾脏病学分会等专业领域学术网站中关于CRRT体外循环的相关证据,包括临床实践指南、临床决策、专家共识、最佳临床实践、证据汇总及系统评价。通过文献质量评价,对符合质量标准的文献进行证据提取及整合。结果共纳入10篇文献,包括临床指南1篇、专家共识2篇、证据综合1篇和系统评价6篇,最后从风险评估、血管通路、耗材选择、抗凝方式、参数设置、过程监测6个方面形成了30条最佳证据。结论临床上行无肝素CRRT时,可结合具体的临床情境,参考最佳证据,降低体外循环凝血的发生,为患者提供专业的护理。

关键词: 连续性肾脏替代治疗, 体外循环, 凝血, 最佳证据, 循证护理

Abstract: Objective To summarize the best evidence for the prevention and management of coagulation during continuous renal replacement therapy (CRRT) without heparin, and to provide reference for clinical practice. Methods The questions were identified based on evidence-based nursing, and we searched the guide websites including the JBI international cooperation center database, Guidelines International Network, and Chinese and English databases including CNKI, PubMed, and professional academic websites including the International Society of Nephrology, and the Chinese Medical Association Nephrology Branch to collect clinical practice guidelines, expert consensus, best clinical practice, evidence summaries and systematic reviews related to CRRT. Then evidence was extracted from the eligible literature through quality evaluation. Results Ten articles were collected, including 1 clinical practice guidelines, 2 expert consensuses, 1 evidence synthesis and 6 systematic reviews. Thirty pieces of best evidence from 6 aspects covering risk assessment, vascular access, consumable materials, heparin-free anti-coagulation, parameters setting, and monitoring during treatment were summed up. Conclusion The best evidence provides guidance for clinical practice, helps to reduce the occurrence of coagulation during heparin-free CRRT and provide patients with professional care.

Key words: continuous renal replacement therapy, extracorporeal circulation, coagulation, best evidence, evidence-based nursing

中图分类号:

R459.5

杨建国, 何细飞, 鄢建军, 张仲华, 童辉, 杨纯子, 王艳芳. 无肝素连续性肾脏替代治疗体外循环凝血预防及管理的最佳证据总结[J]. 护理学报, 2022, 29(10): 54-59.

YANG Jian-guo, HE Xi-fei, YAN Jian-jun, ZHANG Zhong-hua, TONG hui, YANG Chun-zi, WANG Yan-fang. Best Evidence Summary of Prevention and Management of Coagulation during Continuous Renal Replacement Therapy without Heparin[J]. Journal of Nursing, 2022, 29(10): 54-59.

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