术前患者预保温的最佳证据总结

doi:10.16460/j.issn1008-9969.2020.06.017

摘要/Abstract

摘要： 目的检索并综合术前患者实施预保温的最佳证据,为临床实践提供参考。方法根据PICO模式构建循证问题,系统检索2009年1月—2019年12月发布在UpToDate、澳大利亚JBI循证卫生保健中心、英国国家健康与保健优化研究所（The National Institute for Health and Care Excellence,NICE）、德国科学医学会协会(Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesell Schaften, AWMF)、加拿大安大略注册护士协会（Registered Nurses Association of Ontario, RNAO）、Cochrane Library、美国围手术期注册护士协会（The Association of Perioperative Registered Nurses, AORN）、美国围麻醉期护士协会(American Society of Perianesthesia Nurses, ASPAN)、CINAHL、医脉通、PubMed、CNKI、万方、Google学术数据库内所有相关证据,包括指南、系统评价、专家共识、证据总结。由2名组内研究人员运用相关工具独立进行质量评价及证据提取,小组成员共同分析综合最佳证据。结果最终纳入11篇文献进入研究,包括指南4篇,系统评价5篇,专家共识1篇,证据总结1篇。提取48条证据,整合归为10类共28条最佳证据。结论实施预保温是预防围术期低体温的有效措施,临床工作人员及管理者应根据医院资源、制度等在伦理审核允许的情况下实践最佳证据,以提高患者舒适度,降低围术期低体温相关并发症的发生。

关键词: 低体温, 预保温, 围术期, 证据总结

Abstract: Objective To search and synthesize best evidence of preoperative pre-warming of patients and to provide reference for clinical practice. Methods Evidence-based questions were constructed based on PICO model and we systematically retrieved evidence including guidelines, systematic reviews, expert consensus and evidence summary from January 2009 to December 2019 in UpToDate, JBI, NICE, AWMF, RNAO, Cochrane Library, AORN, ASPAN, CINAHL, Yimaitong, Pubmed, CNKI, Wanfang and Google Scholar. Two researchers worked independently to conduct quality evaluation and evidence extraction and all team members jointly analyzed and synthesized the best evidence. Results Eleven articles were included in the study, including 4 guidelines, 5 systematic reviews,1 expert consensus and 1 evidence summary. A total of 48 pieces of evidence were extracted and integrated into 10 categories with a total of 28 pieces of best evidence. Conclusion Pre-warming is an effective measure to prevent perioperative hypothermia. Clinical staff and managers should practice the best evidence according to hospital resources, systems and other ethical review to improve patient comfort and reduce the incidence of perioperative hypothermia-related complications.

Key words: hypothermia, prewarming, prioperative, evidence summary

中图分类号:

R472.3

章明阳, 杜李百合, 罗小平, 章文军, 梁爱群, 常后婵. 术前患者预保温的最佳证据总结[J]. 护理学报, 2020, 27(6): 17-22.

ZHANG Ming-yang, DU Li-baihe, LUO Xiao-ping, ZHANG Wen-jun, LIANG Ai-qun, CHANG Hou-chan. Summary of Best Evidence for Preoperative Pre-warming of Patients[J]. Journal of Nursing, 2020, 27(6): 17-22.

参考文献

[1] Moola S,Lockwood C.Effectiveness of Strategies for the Management and/or Prevention of Hypothermia within the Adult Perioperative Environment[J].Int J Evid Based Healthc, 2011, 9(4):337-345. DOI:10.1111/j.1744-1609.2011.00227.x.
[2] Yi J, Zhan L, Lei Y, et al.Establishment and Validation of a Prediction Equation to Estimate Risk of Intraoperative Hypothermia in Patients Receiving General Anesthesia[J]. Scientific Reports, 2017, 7(1):13927. DOI:10.1038/s41598-017-12997-x.
[3] National Institute for Health and Care Excellence. HumiGard for Preventing Inadvertent Perioperative Hypothermia [EB/OL].(2016-02-08)[2019-12-10]. https://www.nice.org.uk/guidance/mtg31.
[4] Ling ML, Apisarnthanarak A, Abbas A.et al.APSIC Guidelines for the Prevention of Surgical Site Infections[J]. Antimicrob Resist Infect Control,2019(8):174.DOI:10.1186/s13756-019-0638-8.
[5] Iden T, Høcker J.Prevention of Perioperative Hypothermia - Guidelines for Daily Clinical Practice[J].Anasthesiol Intensivmed Notfallmed Schmerzther,2017,52(7/8):554-562. DOI:10.1055/s-0041-103653.
[6] de Brito Poveda V, Clark AM, Galvão CM. A systematic Review on the Effectiveness of Prewarming to Prevent Perioperative Hypothermia[J]. J Clin Nurs, 2013, 22(7/8):906-918. DOI:10.1111/j.1365-2702.2012.04287.x.
[7] Dicenso A, Bayley L, Haynes RB.Accessing Pre-appraised Evidence: Fine-tuning the 5S Model into a 6S Model[J]. Evid Based Nurs. 2009,12(4):99-101. DOI:10.1136/ebn.12.4.99-b.
[8] Advancing the Science of Practice Guidelines (AGREE). Appraisal of Gudelines for Research & Evaluation[EB/OL].(2017-12-05)[2019-12-10].https://www.agreetrust.org/wpcontent/uploads/2018/05/AGREE_II_Domain-Score-interpretation-Chinesesimplified.pdf.
[9] 周芬,郝玉芳,丛雪,等.指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J].护理学报,2018,25(18):56-58. DOI:10.16460/j.issn1008-9969.2018.18.056.
[10] The Joanna Briggs Institute. JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses[EB/OL].[2019-12-10].https://joannabriggs.org/research/critical-appraisal-tools.html.
[11] The Joanna Briggs Institute. JBI Critical Appraisal Checklist for Text and Opinion Papers [EB/OL].[2019-12-10].http://joannabriggs.org/research/critical-appraisal-tools.html.
[12] The Joanna Briggs Institute. Joanna Briggs Institute Levels of Evidence and Grades of Recommendation [EB/OL].(2013-10-01)[2019-12-10].https://joannabriggs.org/jbi-approach.html#tabbed-nav=Levels-of-Evidence.
[13] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[14] Cicchetti, Domenic V. Guidelines, Criteria,Rules of Thumb for Evaluating Normed and Standardized Assessment Instruments in Psychology[J]. Psychol Assess, 1994,6(4):284-290.DOI:10.1037/1040-3590.6.4.284.
[15] 潘晓平,倪宗瓒.组内相关系数在信度评价中的应用[J].华西医科大学学报,1999(1):62-63.DOI:10.3969/j.issn.1672-173X.1999.01.020.
[16] Bashaw MA.Guideline Implementation: Preventing Hypothermia[J]. AORN J, 2016, 103(3):304-313. DOI:10.1016/j.aorn.2016.01.009.
[17] Hooper VD, Chard R, Clifford T, et al.ASPAN’s Evidence-based Clinical Practice Guideline for the Promotion of Perioperative Normothermia: Second Edition[J]. J Perianesth Nurs,2010,25(6):346-365.DOI:10.1016/j.jopan.2010.10.006.
[18] Torossian A, Becke K, Bein B, et al. S3-Leitlinie Vermeidung von Perioperativer Hypothermie “Aktualisierung2019[EB/OL].(2019-05-15)[2019-12-10]. https://www.awmf.org/uploads/tx_szleitlinien/001-018l_S3_Vermeidung_perioperativer_Hypothermie_2019-08.pdf
[19] National Institute for Health and Care Excellence. Hypothermia: Prevention and Management in Adults Having Surgery[EB/OL].(2016-12-01)[2019-12-10]. https://www.nice.org.uk/guidance/cg65/chapter/Update-information.
[20] 余文静,肖瑶,胡娟娟,等.预防围手术期患者低体温的最佳证据总结[J].中华护理杂志,2019,54(4):589-594. DOI:10.3761/j.issn.0254-1769.2019.04.023.
[21] 马正良,易杰.围手术期患者低体温防治专家共识(2017)[J].协和医学杂志,2017, 8(6):352-358.DOI:10.3969/j.issn.1674-9081.2017.06.007.
[22] Forbes SS, Eskicioglu C, Nathens AB, et al.Evidence-Based Guidelines for Prevention of Perioperative Hypothermia[J]. J Am Coll Surg, 2009, 209(4):492-503. DOI:10.1016/j.jamcollsurg.2009.07.002.
[23] Munday J, Hines S, Wallace K, et al.A Systematic Review of the Effectiveness of Warming Interventions for Women Undergoing Cesarean Section[J]. Worldviews Evid Based Nurs, 2014, 11(6):383-393. DOI:10.1111/wvn.12067.
[24] Connelly L, Cramer E, Demott Q, et al.The Optimal Time and Method for Surgical Prewarming:A Comprehensive Review of the Literature[J]. J Perianesth Nurs, 2017, 32(3):199-209. DOI: 10.1016/j.jopan.2015.11.010.
[25] Bjørg Eli Broback, Gjertrud Øvsthus Skutle, Elin Dysvik,et al.Preoperative Warming with a Forced-air Warming Blanket Prevents Hypothermia During Surgery[EB/OL]. (2018-02-26)[2019-12-10].https://sykepleien.no/en/forskning/2018/04/preoperative-warming-forced-air-warming-blanket-prevents-hypothermia-during.
[26] Yancy, Heather J. Preoperative Pre-warming Versus No Preoperative Pre-warming and Intraoperative Hypothermia: An Evidence-based Practice Analysis[EB/OL].(2019-08-21)[2019-12-10]. https://sigma.nursingrepository.org/handle/10755/18299.
[27] Association of Perioperative Registered Nurses. Guideline for Prevention of Hypothermia. In: Guidelines for Perioperative Practice. Denver, CO:AORN, Inc; 2020. In Press [EB/OL].[2019-12-10].https://www.aorn.org/guidelines/clinical-resources/tool-kits/prevention-of-perioperative-hypothermia-pph-tool-kit.
[28] Leslie K, Sessler DI.Perioperative Hypothermia in the High-risk Surgical patient[J]. Best Pract Res Clin Anaesthesiol, 2003,17(4):485-498. DOI:10.1016/s1521-6896(03)00049-1.
[29] Smith CE, Sidhu RS, Lucas L, et al.Should Patients Undergoing Ambulatory Surgery with General Anesthesia be Actively Warmed?[J]. Internet J Anesthesiol. 2007,12(1):18p. DOI:10.5580/1d8d.
[30] Shao L, Zheng H, Jia FJ, et al.Methods of Patient Warming During Abdominal Surgery[J].PLoS One,2012,7(7):e39622.DOI:10.1371/journal.pone.0039622.
[31] Pagnocca ML, Tai EJ, Dwan JL.Temperature Control in Conventional Abdominal Surgery:Comparison between Conductive and the Association of Conductive and Convective Warming[J]. Rev Bras Anestesiol, 2009,59(1):56-66. DOI: 10.1590/S0034-70942009000100008.
[32] Kim P, Taghon T, Fetzer M, et al.Perioperative Hypothermia in the Pediatric Population:A Quality Improvement Project[J]. Am J Med Qual, 2013,28(5):400-406. DOI:10.1177/1062860612473350.
[33] Wagner D, Byrne M, Kolcaba K.Effects of Comfort Warming on Preoperative Patients[J]. AORN J, 2006,84(3):427-448. DOI:10.1016/S0001-2092(06)63920-3.
[34] Horn EP, Bein B, Böhm R, et al.The Effect of Short Time Periods of Pre-operative Warming in the Prevention of Peri-operative Hypothermia[J]. Anaesthesia, 2012,67(6):612-617. DOI:10.1111/j.1365-2044.2012.07073.x.
[35] Horn EP, Klar E, Höcker J, et al.Vermeidung Perioperativer Hypothermie: Umsetzung der S3-Leitlinie [Prevention of Perioperative Hypothermia: Implementation of the S3 Guideline][J]. Chirurg. 2017,88(5):422-428. DOI:10.1007/s00104-016-0357-0.
[36] AORN. Guideline at a Glance: Hypothermia[J]. AORN J, 2017,105(3):342-344.DOI:10.1016/S0001-2092(17)30093-5.
[37] Llewellyn L.Effect of Pre-warming on Reducing the Incidence of Inadvertent Peri-operative Hypothermia for Patients Undergoing General Anaesthesia: A Minireview[J]. Br J Anaesth Recov Nurs, 2013,14(1):3-10.
[38] Horn EP, Schroeder F, Gottschalk A, et al.Active Warming During Cesarean Delivery[J].Anesthesia Analgesia, 2002,94(2):409-414.DOI:10.1097/00000539-200202000-00034.
[39] Bräuer A, Waeschle RM, Heise D,et al.Preoperative Prewarming as a Routine Measure.First experiences[J]. Anaesthesist, 2010, 59(9):842-850.DOI:10.1097/00000539-200202000-00034.
[40] Camus Y, Delva E, Sessler DI, et al.Pre-induction Skin-surface Warming Minimizes Intraoperative Core Hypothermia[J]. J Clin Anesth, 1995, 7(5):384-388.DOI:10.1016/0952-8180(95)00051-i.

Metrics

Viewed

Full text

Abstract

Cited

Shared