目的:目前关于脓毒症患者重症监护病房获得性衰弱(intensive care unit-acquired weakness,ICU-AW)防治效果的研究不尽相同,且缺乏系统有效的循证护理方案.本研究基于循证护理理念对脓毒症患者ICU-AW预防与管理的证据进行检索、分析和整合,以期为临床护理实践提供理论依据.方法:系统检索英国国家卫生与临床优化研究所指南网、美国国立指南网、BMJ最佳临床实践、国际指南协作网、苏格兰院际指南网、加拿大安大略注册护士协会指南网、乔安娜布里格斯研究所循证卫生保健中心数据库、PubMed、Embase、CINAHL、UpToDate、Cochrane Library、Scopus、中国知网、万方数据库、维普数据库、中国生物医学文献数据库、医脉通关于脓毒症患者ICU-AW预防与管理的临床指南、最佳实践信息手册、临床决策、证据总结、系统评价、专家共识、随机对照研究等.检索时限为建库至2024年2月5日.2名研究人员对纳入文献进行质量评价,按纳入和排除标准对相关文献进行证据提取与分析.结果:最终纳入13篇文献,其中6篇随机对照研究,3篇指南、2篇系统评价、2篇专家共识,形成25条证据,包含ICU-AW的诊断方法、康复技术开始的时机、康复技术实施前的评估、康复技术实施的方法、安全评价标准、安全性及可行性、健康教育7个主题.结论:本研究总结了脓毒症患者ICU-AW预防及管理的相关策略,临床医护人员可根据实际情境个性化地引用相关证据,以实现对脓毒症患者ICU-AW防治的科学管理.
Best evidence for the prevention and management of ICU-acquired weakness in sepsis patients
Objective:Current studies on the prevention and management of intensive care unit-acquired weakness(ICU-AW)in sepsis patients show inconsistent results and lack a systematic evidence-based nursing protocol.This study aims to retrieve,analyze,and integrate evidence for ICU-AW prevention and management in sepsis patients based on evidence-based nursing principles,providing a theoretical basis for clinical nursing practice.Methods:A systematic search was conducted in databases and guideline repositories,including the National Institute for Health and Care Excellence,National Guideline Clearinghouse,BMJ Best Practice,Guidelines International Network,Scottish Intercollegiate Guidelines Network,Registered Nurses'Association of Ontario,Joanna Briggs Institute Evidence-Based Health Care Center Database,PubMed,Embase,CINAHL,UpToDate,Cochrane Library,Scopus,CNKI,Wanfang Database,VIP Database,SinoMed,and Medlive.Sources included clinical guidelines,best practice information sheets,clinical decisions,evidence summaries,systematic reviews,expert consensus,and randomized controlled trials on ICU-AW prevention and management in sepsis patients.The search covered publications up to February 5,2024.Two researchers independently assessed the quality of included studies and extracted and analyzed relevant evidence based on inclusion and exclusion criteria.Results:A total of 13 documents were included:6 randomized controlled trials,3 guidelines,2 systematic reviews,and 2 expert consensuses.25 pieces of evidence were synthesized,encompassing 7 themes:diagnostic methods for ICU-AW,timing of rehabilitation techniques,pre-assessment before implementing rehabilitation techniques,methods of rehabilitation techniques,safety evaluation standards,safety and feasibility,and health education.Conclusion:This study summarizes strategies for the prevention and management of ICU-AW in sepsis patients.Clinical healthcare providers can personalize and adapt these evidence-based strategies according to practical contexts to achieve scientific management of ICU-AW in sepsis patients.