摘要
目的 检索、评价并总结应用静脉-动脉体外膜肺氧合(VA-ECMO)成人患者预防肢体缺血的最佳证据,为临床护理实践提供参考.方法 按照"6S"证据模型在国内外数据库自上而下进行证据检索,包括临床决策、指南、专家共识、证据总结、系统评价、meta分析、随机对照试验等,由3名研究员对文献质量进行独立评价、证据提取和证据汇总.检索时限为2014年6月30日至2024年6月30日.结果 共纳入13篇文献,其中指南2篇,临床决策1篇,专家共识5篇,系统评价4篇,随机对照试验1篇,从血管选择、导管选择、设备管理、血压和体温管理、抗凝管理、早期监测与评估、分级管理等7个方面汇总了 21条证据.结论 该研究总结了应用VA-ECMO成人患者预防肢体缺血的最佳证据,可为医护人员针对VA-ECMO肢体缺血并发症的预防实施科学有效的规范化管理提供依据.
Abstract
Objective To search,evaluate,and summarize the best evidence for preventing limb ischemia for adult patients with venoarterial extracorporeal membrane oxygenation(VA-ECMO),and to provide reference for clinical nursing practice.Methods According to"6S"evidence model,clinical decisions,guidelines,expert consensuses,evidence summaries,systematic reviews,meta-analysis,and randomized controlled trials for preventing limb ischemia for adult patients with VA-ECMO were top-down searched by computer in domestic and international databases.Three researchers independently appraised articles and extracted data for eligible studies.The retrieval period was from June 30,2014 to June 30,2024.Results A total of 13 articles were enrolled,including two guidelines,one clinical decision,five expert consensuses,four systematic reviews,and one randomized controlled trial.Totally 21 items of best evidence were summarized from seven aspects:vascular selection,catheter selection,device management,blood pressure,and temperature management,anticoagulation management,early monitoring and evaluation,and categorization management.Conclusion This study summarizs the best evidence on the application of VA-ECMO in adult patients for the prevention of limb ischemia,which can provide evidence-based references for medical staff to implement scientifically and effectively standardized management of the prevention of limb ischemia complications of VA-ECMO.
维普
万方数据