脊髓损伤神经源性肠道功能障碍相关指南的质量评价及内容分析

doi:10.16460/j.issn1008-9969.2024.16.044

摘要/Abstract

摘要： 目的对国内外脊髓损伤神经源性肠道功能障碍相关指南进行质量评价和内容分析,为临床开展以证据为基础的脊髓损伤神经源性肠道功能障碍护理实践提供参考。方法系统检索BMJ Best Practice、国际指南协作网、美国国立指南文库、英国国家临床医学研究所、苏格兰校际指南网、安大略省注册护士协会、美国脊髓损伤学会、美国残疾退伍军人协会、医脉通临床指南库、PubMed、Web of Science、CINAHL、Cochrane Library、Ovid数据库、万方、中国知网、中华医学期刊全文数据库中的相关指南,采用AGREEⅡ对纳入的循证指南进行质量评价,采用JBI的专家共识评价标准对专家共识类指南进行质量评价,运用内容分析法整合指南的推荐意见。结果最终纳入10篇文献,其中6篇循证指南,4篇专家共识类指南。3篇循证指南的质量评价结果为A级,3篇结果为B级。10篇指南内容分析汇总为分类、护理目标、评估、基础肠道护理、药物护理、肠道灌洗、电和磁刺激、并发症预防、健康教育和护理记录10个主题27条推荐意见。结论本研究整合了脊髓损伤神经源性肠道功能障碍相关指南中护理相关内容,总结10个主题,内容丰富,整体质量较高,部分争议内容有待进一步研究。国内脊髓损伤神经源性肠道功能障碍护理指南欠缺,需组建多学科小组构建符合国内临床情境的护理指南。

关键词: 脊髓损伤, 神经源性肠道功能障碍, 指南, 质量评价, 内容分析

Abstract: Objective To evaluate the quality of nursing guidelines for neurogenic bowel dysfunction (NBD) after spinal cord injury (SCI) and to provide reference for evidence-based nursing practice of NBD after SCI. Methods We conducted a systematic search of relevant guidelines in BMJ Best Practice, Guidelines International Network, National Guideline Clearinghouse, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, The Registered Nurses' Association of Ontario, American Spinal Injury Association, Disabled American Veterans, Medlive Guideline, PubMed, Web of Science, CINAHL, Cochrane Library, Ovid databases, Wanfang Data, CNKI, and Chinese Medical Journal Full-text Database. The quality assessment of the included evidence-based guidelines was performed using the AGREE II tool, while that of the expert consensus guidelines using the JBI consensus evaluation criteria. The recommendations from the guidelines were synthesized using content analysis. Results A total of 10 articles were included, including 6 evidence-based guidelines and 4 expert consensus guidelines. Among the evidence-based guidelines, 3 were rated as Grade A, and 3 as Grade B. The content analysis of the 10 guidelines resulted in 27 recommendations across 10 themes, including classification, nursing goals, assessment, basic bowel care, medication nursing, bowel irrigation, electrical and magnetic stimulation, prevention of complications, health education, and nursing documentation. Conclusion This study summarizes nursing-related content in guidelines for NBD after SCI. The overall quality of the included guidelines is relatively high, and the study identifies 10 themes with in-depth content. However, there are some controversial topics requiring further research. There is a lack of nursing guidelines for NBD after SCI in China, and it is necessary to establish multidisciplinary teams to develop nursing guidelines that are suitable for domestic nursing practice.

Key words: spinal cord injury, neurogenic bowel dysfunction, guideline, quality evaluation, content analysis

中图分类号:

R473.6

杨中善, 张丽华, 许妮娜, 詹昱新, 欧阳燕, 王羡科, 刘淼, 李鹏飞. 脊髓损伤神经源性肠道功能障碍相关指南的质量评价及内容分析[J]. 护理学报, 2024, 31(16): 44-49.

YANG Zhong-shan, ZHANG Li-hua, XU Ni-na, ZHAN Yu-xin, OU Yang-yan, WANG Xian-ke, LIU Miao, LI Peng-fei. Quality evaluation and content analysis of nursing guidelines for neurogenic bowel dysfunction after spinal cord injury[J]. Journal of Nursing, 2024, 31(16): 44-49.

参考文献

[1] White AR, Holmes GM.Investigating neurogenic bowel in experimental spinal cord injury: where to begin?[J].Neural Regen Res, 2019, 14(2):222-226. DOI:10.4103/1673-5374.244779.
[2] 曹效,廖利民.乙状结肠膀胱扩大术后神经源性肠道患者排便状况的研究[J]. 中国临床医生杂志, 2019, 47(1):4. DOI:10.3969/j.issn.2095-8552.2019.01.022.
[3] Ture SD, Ozkaya G, Sivrioglu K.Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury[J]. J Spinal Cord Med, 2023,46(3):424-432. DOI:10.1080/10790268.2021.2021043.
[4] Weitzenkamp DA, Jones RH, Whiteneck GG, et al.Ageing with spinal cord injury: cross-sectional and longitudinal effects[J]. Spinal Cord, 2001,39(6):301-309. DOI: 10.1038/sj.sc.3101146.
[5] Johns JS, Krogh K, Ethans K, et al.Pharmacological management of neurogenic bowel dysfunction after spinal cord injury and multiple sclerosis: a systematic review and clinical implications[J]. J Clin Med,2021,10(4):882. DOI:10.3390/jcm10040882.
[6] Guiho T, Azevedo-Coste C, Bauchet L, et al.Sacral anterior root stimulation and visceral function outcomes in spinal cord injury-a systematic review of the literature over four decades[J]. World Neurosurg, 2022,157:218-232. DOI:10.1016/j.wneu.2021.09.041.
[7] 庄维崧,彭娟娟,白子荣,等.脊髓损伤神经源性肠道功能障碍康复干预进展[J].中国康复医学杂志,2021,36(6):743-747. DOI:10.3969/j.issn.1001-1242.2021.06.021.
[8] 冯加义,彭道娟,高奉琼,等.脊髓损伤伴神经源性肠功能障碍病人肠道功能评估方法研究现状[J].护理研究,2023,37(4):640-644.DOI:10.12102/j.issn.1009-6493.2023.04.014.
[9] 刘畅,王晓梅,高兴,等.30例脊髓损伤后神经源性肠道功能障碍患者的护理[J].护理学报,2020,27(24):57-59. DOI:10.16460/j.issn1008-9969.2020.24.057.
[10] 朱政,胡雁,邢唯杰,等.不同类型循证问题的构成[J].护士进修杂志,2017, 32(21):1991-1994. DOI:10.16821/j.cnki.hsjx.2017.21.025.
[11] McArthur A, Klugárová J, Yan H, et al. Innovations in the systematic review of text and opinion[J].Int J Evid Based Healthc,2015, 13(3):188-195.DOI:10.1097/XEB.0000000000000060.
[12] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: advancing guideline development, reporting, and evaluation in health care[J]. Prev Med, 2010, 51(5):421-424. DOI: 10.1016/j.ypmed.2010.08.005.
[13] 卜丝丝,李玉红,丁礼雪,等.妊娠期女性身体活动指南的质量评价及内容分析[J].护理学报, 2023, 30(4):49-54. DOI:10.16460/j.issn1008-9969.2023.04.049.
[14] Johns J, Krogh K, Rodriguez GM, et al.Management of neurogenic bowel dysfunction in adults after spinal cord injury: clinical practice guideline for health care providers[J]. Top Spinal Cord Inj Rehabil, 2021, 27(2):75-151.DOI:10.46292/sci2702-75.
[15] 李建军,杨明亮,杨德刚,等. “创伤性脊柱脊髓损伤评估,治疗与康复”专家共识[J]. 中国康复理论与实践, 2017, 23(3):274-287. DOI:10.3969/j.issn.1006-9771.2017.03.007.
[16] Kurze I, Geng V, Böthig R.Guideline for the management of neurogenic bowel dysfunction in spinal cord injury/disease[J]. Spinal Cord, 2022, 60(5):435-443.DOI:10.1038/s41393-022-00786-x.
[17] Beierwaltes P, Church P, Gordon T, et al.Bowel function and care: guidelines for the care of people with spina bifida[J]. J Pediatr Rehabil Med, 2020,13(4):491-498.DOI: 10.3233/PRM-200724.
[18] Tate DG, Wheeler T, Lane GI, et al.Recommendations for evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease[J].J Spinal Cord Med, 2020,43(2):141-164.DOI:10.1080/10790268.2019.1706033.
[19] Cotterill N, Madersbacher H, Wyndaele JJ, et al.Neurogenic bowel dysfunction: clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International consultation on Incontinence 2013[J]. Neurourol Urodyn, 2018, 37(1):46-53. DOI:10.1002/nau.23289.
[20] Multidisciplinary Association of Spinal Cord Injured Professionals. Guidelines for management of neurogenic bowel dysfunction in individuals with a spinal cord injury and other central neurological conditions[EB/OL]. [2021-02-03].https://www.mascip.co.uk/wp-content/uploads/2022/02/Feb-2021-MASCIP-Neurogenic-Bowel-Guidlines-text.pdf
[21] National Institute for Health and Care Excellence. Peristeen Plus transanal irrigation system for managing bowel dysfunction[EB/OL].[2022-06-06].https://www.nice.org.uk/guidance/mtg36.
[22] State Spinal Cord Injury Service. Management of the neurogenic bowel for adults with spinal cord injuries[EB/OL]. [2022-01-01].http://aci.health.nsw.gov.au/publications/neurogenic-bowel/introduction.
[23] Coggrave M, Mills P, Willms R, et al.Bowel dysfunction and management following spinal cord injury[EB/OL]. [2021-01-01].https://scireproject.com/wp-content/uploads/2022/02/S5_bowel_management.pdf.
[24] 高馨,李伦兰,戴晴等.脊髓损伤患者居家康复体验的质性研究[J].中华护理杂志,2021,56(11):1691-1697.
[25] Khadour FA, Khadour YA, Xu J, et al.Effect of neurogenic bowel dysfunction symptoms on quality of life after a spinal cord injury[J]. J Orthop Surg Res,2023,18(1):458. DOI:10.1186/s13018-023-03946-8.
[26] Dehghan M, Malakoutikhah A, Ghaedi Heidari F, et al.The effect of abdominal massage on gastrointestinal functions: a systematic review[J]. Complement Ther Med, 2020, 54:102553. DOI: 10.1016/j.ctim.2020.102553.
[27] Coggrave M, Norton C, Wilson-Barnett J.Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom[J].Spinal Cord, 2009, 47(4):323-330. DOI:10.1038/sc.2008.137.

相关文章 15

[1]	蔡莹莹, 凌晨, 刘绵珠, 周杰, 张俊峰, 陈连华, 田潇飞, 罗斌, 陈梦云. 成人癌痛评估与管理指南的方法学质量评价[J]. 护理学报, 2025, 32(4): 34-40.
[2]	刘硕怡, 熊莉娟, 李凌, 王玉梅, 何嘉, 李鑫, 袁淑蕾, 郭雪琴, 王暘婧, 张慧娟. 老年住院患者衰弱预防及管理临床实践指南的质量评价及内容分析[J]. 护理学报, 2025, 32(2): 50-55.
[3]	倪乐凤, 刘林, 沈春华, 乔瑶, 周亮, 朱强, 龚卫娟. 输血护理时限管理相关指南的质量评价及内容分析[J]. 护理学报, 2024, 31(7): 51-56.
[4]	陈丽燕, 任俊, 董辉, 陈慕莹, 罗伟香. 成人糖尿病患者低血糖管理的指南质量评价及内容分析[J]. 护理学报, 2024, 31(22): 41-47.
[5]	苟昕雨, 吴静, 韦翠翠, 詹水荣, 杜培云, 吴爱荣. 神经源性肠道功能障碍对脊髓损伤患者生存质量影响的结构方程分析[J]. 护理学报, 2024, 31(20): 13-18.
[6]	梁慧, 王建宁, 张艺, 胡娇娇, 龚翠颖, 李立群. 卧床患者压力性损伤管理指南的质量评价及内容分析[J]. 护理学报, 2024, 31(16): 50-55.
[7]	代荣琴, 刘玉枝, 陈洋, 张金彪, 郭振彬, 李卫, 郭东辉, 高峰, 卢越. 医院内静脉血栓栓塞症防治质量评价与管理指南（2022版）中血栓指标的解读及防治建议[J]. 护理学报, 2024, 31(13): 35-39.
[8]	. 临床血压标准化测量实践的田野调查[J]. 护理学报, 2024, 31(12): 13-17.
[9]	黄子菁, 王颖, 朱丽, 马婉秋, 杜玫洁, 崔梦影, 蔡悦, 张昕悦, 陈敏, 鲁志卉. 胃肠道肿瘤患者术前口服营养补充指南的质量评价及内容分析[J]. 护理学报, 2024, 31(11): 42-47.
[10]	郭玉, 魏薇, 白冰, 李胜云. 以患者为中心的临床护理干预创新质量评价指标体系的构建[J]. 护理学报, 2023, 30(6): 7-11.
[11]	卜丝丝, 李玉红, 丁礼雪, 李文娟. 妊娠期女性身体活动指南的质量评价及内容分析[J]. 护理学报, 2023, 30(4): 49-54.
[12]	冯小莹, 吴培香, 孙雪琪, 苑潇敏, 陈兰波. 冠心病经皮冠状动脉介入术后患者中西医结合康复护理质量评价指标体系的构建[J]. 护理学报, 2023, 30(19): 1-6.
[13]	薛翠翠, 滕宏旭, 张荣, 刘华平, 田建丽. 我国优质护理资源下沉政策文本研究[J]. 护理学报, 2023, 30(17): 20-23.
[14]	冯宪凌, 白杨, 古钰君. 《儿童、青少年和年轻成人癌症幸存者癌因性疲乏监测》解读[J]. 护理学报, 2022, 29(24): 64-67.
[15]	杨紫晗, 翟惠敏, 梁思静. 基于内容分析法的本科护理专业教师课程人文胜任力元素分析[J]. 护理学报, 2022, 29(22): 1-5.

Metrics

Viewed

Full text

Abstract

Cited

Shared