体外循环心脏手术中体温管理证据汇总

doi:10.16460/j.issn1008-9969.2021.05.026

摘要/Abstract

摘要： 目的检索并总结体外循环心脏手术中体温管理相关证据,为临床进行规范化的术中低温治疗及复温管理提供依据。方法应用PICO程式结构化临床问题,确定“体外循环心脏手术患者的体温管理”为研究问题,检索中国指南网,美国指南网,英国国家临床医学研究所指南库,国际指南图书馆,英格兰学院间指南网,Up To Date,BMJ-Best Practice,Cochrane图书馆,PubMed,Web of Science,EMbase,CINAHL,中国生物医学数据库,中国知网,万方医学数据库,医脉通指南网。采用AGREEⅡ、AMSTAR 2、GRADE评价工具对纳入的文献进行质量评价。结果共纳入文献12篇,包括指南3篇,证据汇总2篇,系统评价7篇,最终提取17条证据,总结出15条审查指标,包括术前评估,预保温,体温监测,浅/中/深低温体外循环手术的降温和复温速率、目标值、温度梯度,复苏时的体温管理等具体内容。结论建议医务人员结合自身经验、临床情景及患者的意愿应用证据,并及时对证据进行更新,以期临床采用科学的方法进行体外循环手术患者的体温管理,确保体外循环手术患者的安全。

关键词: 心脏外科, 体外循环技术, 低温治疗, 体温管理, 循证实践

Abstract: Objective To retrieve and summarize the evidence on body temperature management in cardiac surgery with extracorporeal circulation, and to provide basis for clinical standardized intraoperative hypothermia treatment. Methods With PICO procedure, the research topic of “temperature management of patients undergoing cardiac surgery with extracorporeal circulation” was identified, then the search for eligible literature was conducted in China Guideline Network, National Guideline Clearinghouse, National Institute for Health and Care Excellence, Guidelines International Network, Scottish Intercollegiate Guidelines Network, UpToDate, BMJ-Best Practice, Cochrane Library, Pubmed, Web of Science , EMbase, CINAHL, China Biomedical Database, China Knowledge Network, Wanfang Medical Database and Medical Pulse Flux. The quality and grade of eligible studies were evaluated using the literature quality evaluation tool of AGREE 1I, AMSTAR 2 and GRADE. Results Twelve articles were included in this study, including 3 clinical practice guideline,2 evidence summary and 7 systematic reviews,and finally 17 pieces of evidence were extracted. Fifteen review indicators, including preoperative evaluation, pre-incubation, body temperature monitoring, and low temperature jump, shallow/medium temperature stop jump, cooling and rewarming rate of deep hypothermia circulation arrest surgery, peak, temperature gradient, and body temperature management during resuscitation were summarized. Conclusion Evidence should be applied based on the experience of medical staff, clinical situation and patient's wishes and should be updated in time to ensure scientific nursing for body temperature management in cardiac surgery with extracorporeal circulation so as to improve intraoperative care quality.

Key words: cardiac surgery, techniques in extracorporeal circulation, hypothermia treatment, body temperature management, evidence-based practice

中图分类号:

R473.6

周毅峰, 杨继平, 袁浩, 吴娟. 体外循环心脏手术中体温管理证据汇总[J]. 护理学报, 2021, 28(5): 26-31.

ZHOU Yi-feng, YANG Ji-ping, YUAN Hao, WU Juan. Evidence Summary of Body Temperature Management in Cardiac Surgery with Extracorporeal Circulation[J]. Journal of Nursing, 2021, 28(5): 26-31.

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