摘要
目的 检索、评价和整合腰椎开放性手术患者术后早期下床活动的最佳证据.方法 系统检索UpToDate、BMJ最佳临床实践、国际指南协作网、英国国家卫生与临床优化研究所、美国卫生保健研究与质量机构、苏格兰校际指南网、加拿大安大略注册护士协会、医脉通、北美脊柱协会、加拿大多伦多大学普外科最佳实践组织、ERAS协会、PubMed、Embase、Web of Science、Medline、中国知网和万方数据库中腰椎开放性手术患者术后早期下床活动相关文献,包括指南、专家共识、证据总结、推荐实践、系统评价和高质量原始研究.检索时限为2014年1月1日—2023年6月20日.由2名研究者独立对文献质量进行评价和资料提取.结果 共纳入23篇文献,包括指南3篇、系统评价2篇、专家共识6篇、随机对照研究7篇、类实验研究1篇、队列研究4篇.最终汇总为多学科团队合作、健康教育、促进措施、活动前评估、活动内容和安全保障6个主题,提取出25条证据.结论 本研究总结了25条关于腰椎开放性手术患者术后早期下床活动的最佳证据;建议医护人员应用证据时须结合临床实际情况和患者个体差异,多学科合作制订个性化早期下床活动方案.
Abstract
Objective To retrieve,evaluate,and integrate the best evidence for early ambulation in patients undergoing open lumbar surgery.Methods A systematic search was conducted in databases including UpToDate,British Medical Journal(BMJ)Best Practice,Guidelines International Network(GIN),The National Institute for Health and Care Excellence(NICE),The Agency for Healthcare Research and Quality(AHRQ),Scottish Intercollegiate Guidelines Network(SIGN),Registered Nurses'Association of Ontario(RNAO),Medlive,North American Spine Society(NASS),Best Practice in General Surgery Group from the University of Toronto,ERAS® Society,PubMed,Embase,Web of Science,Medline,CNKI,and Wanfang.The search included literature on early ambulation post-open lumbar surgery,such as guidelines,expert consensus,evidence summaries,recommended practices,systematic reviews,and high-quality original research.The search period was from January 1,2014,to June 20,2023.Two researchers independently evaluated the quality of the literature and extracted relevant data.Results A total of 23 articles were included,comprising three guidelines,two systematic reviews,six expert consensus statements,seven randomized controlled trials,one quasi-experimental study,and four cohort studies.The evidence was categorized into six themes:multidisciplinary team collaboration,health education,facilitation measures,pre-activity assessment,activity content,and safety assurance,resulting in 25 evidence-based recommendations.Conclusions This study summarizes 25 best evidence-based recommendations for early ambulation in patients undergoing open lumbar surgery.Healthcare providers are advised to apply these recommendations in clinical practice while considering the specific clinical context and individual patient differences.Multidisciplinary collaboration is essential to develop personalized early ambulation plans.
基金项目
北京大学第三医院护理科研基金(BYSYHL2022014)
NETL
NSTL
万方数据