狗咬伤患者伤口感染预防及管理的最佳证据总结

doi:10.16460/j.issn1008-9969.2022.05.052

摘要/Abstract

摘要： 目的总结狗咬伤患者伤口感染预防及管理的最佳证据,为伤口护理实践提供参考。方法采用PIPOST工具确立循证问题,计算机检索Up To Date、BMJ、JBI、NICE、SIGN、RNAO、EWMA、Cochrane Library、Embase、CINAHL、PubMed、Web of Science、CBM、Wanfang、CNKI,筛选符合纳入标准的文献,由2名研究生对文献进行独立评价、证据提取与证据整合。结果最终纳入8篇文献,包括1篇临床指南,1篇系统评价,2篇证据总结,1篇临床决策,3篇专家共识,最佳证据涉及伤口准备、伤口缝合、感染伤口的处理及抗菌药物的应用,共4个维度,12条最佳证据。结论临床医护人员处理狗咬伤时需综合考虑伤口情况、患者意愿、应用证据的促进与阻碍因素等,并及时关注证据更新情况,选用针对性的循证证据改进临床实践、降低伤口感染率。

关键词: 狗咬伤, 伤口感染, 伤口护理, 证据总结, 循证护理

Abstract: Objective To summarize the best evidence of the prevention and management of dog bite wound infection. Methods Databases including Up To Date, BMJ, JBI, NICE, SIGN, RNAO, EWMA, Cochrane Library, Embase, CINAHL, PubMed, Web of Science, CBM, Wanfang, and CNKI were searched for literature that met the inclusion criteria, and two graduate students independently evaluated the literature, extracted and integrated the evidence. Results There were 8 articles, including 1 clinical guideline, 1 systematic evaluation, 2 evidence summaries, 1 clinical decision and 3 expert consensus. Twelve pieces of best evidences were summarized into 4 themes: wound preparation, wound suture, treatment of infected wound and application of antibiotics were summarized. Conclusion When dealing with dog bite wounds, clinical medical staffs should take the wound, patient willingness, promotion and obstruction factors of evidence application into account, pay attention to the updated evidence, so as to select targeted evidence-based evidence to improve clinical practice and reduce wound infection rate.

Key words: dog bite, wound infection, wound care, evidence summary, evidence-based nursing

中图分类号:

R473

吴玉洁, 吴利平, 冷虹瑶, 王燕, 林光燕. 狗咬伤患者伤口感染预防及管理的最佳证据总结[J]. 护理学报, 2022, 29(5): 52-56.

WU Yu-jie, WU Li-ping, LENG Hong-yao, WANG Yan, LIN Guang-yan. Best Evidence Summary of Prevention and Management of Dog Bite Wound Infection[J]. Journal of Nursing, 2022, 29(5): 52-56.

参考文献

[1] 中国医师协会急诊医师分会,中国人民解放军急救医学专业委员会,北京急诊医学学会,等.中国犬咬伤治疗急诊专家共识(2019)[J].解放军医学杂志,2019,44(8):636-642. DOI: 10.11855/j.issn.0577-7402.2019.08.02.
[2] 世界卫生组织.动物咬伤[EB/OL].(2018-02-05)[2020-05-06].https://www.who.int/zh/news-room/fact-sheets/detail/animal-bites.
[3] Bula-Rudas FJ, Olcott JL.Human and Animal Bites[J].Pediatr in Rev,2018,39(10):490-500.DOI:10.1542/pir.2017-0212.
[4] 奥海航,郝永发,齐喜娟,等.宁夏2011-2014年狂犬病病例流行病学及临床特征分析[J].宁夏医科大学学报, 2015, 37(4):442-445.DOI:10.16050/j.cnki.issn1674-6309.2015.04.023.
[5] 杨云娟,金华忠,肖义泽.云南省禄丰县2006-2013年儿童动物咬伤流行特征[J].实用预防医学, 2015, 22(9):1118-1121. DOI:10.3969/j.issn.1006-3110.2015.09.032.
[6] Rajshekar M, Blizzard L, Julian R, et al.The Incidence of Public Sector Hospitalisations Due to Dog Bites in Australia 2001-2013[J]. Aust N Z J Public Health, 2017, 41(4):377-380. DOI:10.1111/1753-6405.12630.
[7] Cook JA, Sasor SE, Soleimani T, et al.An Epidemiological Analysis of Pediatric Dog Bite Injuries Over a Decade[J].J Surg Res,2020,246:231-235. DOI:10.1016/j.jss.2019.09.013.
[8] 杨旭红,黄素群.改良式负压封闭引流技术联合局部氧疗在犬咬伤Ⅲ级暴露创面的应用[J].护理学杂志,2017,32(18):11-13.DOI:10.3870/j.issn.1001-4152.2017.18.011.
[9] Rothe K, Tsokos M, Handrick W.Animal and Human Bite Wounds[J].Dtsch Arztebl Int, 2015, 112(25):433-442. DOI: 10.3238/arztebl.2015.0433.
[10] 宋艳萍.狂犬咬伤处置暴露不当致狂犬病患者死亡1例分析与启示[J].护理学报,2017,24(4):75.
[11] 李丹丹,郑维民,赵东梅,等. 国内外伤口、造口、失禁护理专科护士培训体系发展现状[J]. 护理研究,2015,29(9): 1040-1042. DOI:10.3969/j.issn.1009-6493.2015.09.006.
[12] 张振波,赵聪,王雷,等.口腔颌面部狗咬伤患者一期缝合与延期缝合的疗效比较[J].吉林大学学报(医学版), 2016, 42(6):1207-1210. DOI:10.13481/j.1671-587x.20160631.
[13] Drumright B,Borg B,Rozzelle A,et al.Pediatric Dog Bite Outcomes: Infections and Scars[J].Trauma Surg Acute Care Open, 2020,5(1):e445.DOI:10.1136/tsaco-2020-000445.
[14] 朱政,胡雁,邢唯杰,等.不同类型循证问题的构成[J].护士进修杂志,2017,32(21):1991-1994.DOI:10.16821/j.cnki.hsjx.2017.21.025.
[15] 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.
[16] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: Advancing Guideline Development,Reporting and Evaluation in Health Care[J].Can Med Assoc J,2010,182(18):E839-E842.DOI:10.1503/cmaj.090449.
[17] 熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR[J].中国循证医学杂志,2011,11(9):1084-1089.
[18] The Joanna Briggs Institute. Joanna Briggs Institute Reviewers’ Manual:2016 Edition[M].Australia:The Joanna Briggs Institute, 2016.
[19] 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.
[20] Stevens DL, Bisno AL,Chambers HF, et al.Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America[J].Clin Infect Dis, 2014, 59(2):147-159. DOI:10.1093/cid/ciu444.
[21] Bhaumik S, Kirubakaran R, Chaudhuri S. Primary Closure Versus Delayed or No Closure for Traumatic Wounds Due to Mammalian Bite[J].Cochrane Database Syst Rev, 2019 (12):CD011822. DOI:10.1002/14651858.CD011822.pub2.
[22] Giles DK. Primary Wound Closure: Community Settings[EB/OL].(2018-03-29)[2020-05-06].http://ovidsp.dc2.ovid.com/sp-4.04.0a/ovidweb.cgi.
[23] Baddour LM, Harper M. Animal Bites (Dogs, Cats,Other Animals):Evaluation and Management[EB/OL].(2020-01-28)[2020-05-06].https://www-uptodate-com.ermg.femh.org.tw/contents/animal-bites-dogs-cats-and-other-animals-evaluation-and-management?search=Animal%20bites%20(dogs,%20cats,%20and%20other%20animals):%20Evaluation%20and%20management&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H13.
[24] 陈庆军,王传林,刘斯等.动物致伤专家共识[J].中国急救复苏与灾害医学杂志, 2018,13(11):1056-1061.
[25] 中华医学会创伤学分会创伤感染学组, 中华医学会急诊医学分会创伤学组.创伤后抗菌药物预防性应用专家共识[J].中华急诊医学杂志,2016,25(10):1224-1228.
[26] Paschos NK, Makris EA, Gantsos A, et al.Primary Closure Versus Non-closure of Dog Bite Wounds. A Randomised Controlled Trial[J].Injury, 2014, 45(1):237-240. DOI:10.1016/j.injury.2013.07.010.
[27] Tabaka ME, Quinn JV, Kohn MA, et al.Predictors of Infection from Dog Bite Wounds:Which Patients May Benefit from Prophylactic Antibiotics?[J].Emerg Med J,2015,32(11):860-863.DOI:10.1136/emermed-2014-204378.
[28] Kannikeswaran N, Kamat D.Mammalian Bites[J].Clin Pediatr (Phila),2009,48(2):145-148.DOI:10.1177/0009922808324494.
[29] 刘清娴,苏静,陈文专,等.TIME伤口床准备联合封闭式负压引流用于慢性伤口护理[J].护理学杂志,2017,18:1-6.
[30] 杨明,赵雄.儿童颌面部狗咬伤急诊美容缝合的临床效果观察[J].中国医疗美容,2018(1):31-34.
[31] 罗昱澜,莫碧文,尹友生,等.阿莫西林克拉维酸钾颗粒(8:1)治疗呼吸和泌尿系统细菌性感染的双盲随机对照试验[J].实用医学杂志,2014,30(1):129-131. DOI:10.3969/j.issn.1006-5725.2014.01.044.
[32] 胡汉军,叶志华.阿莫西林克拉维酸钾治疗儿童肺炎的临床疗效及安全性分析[J].中国医刊,2015,50(2):104-106.DOI:10.3969/j.issn.1008-1070.2015.02.031.
[33] 冯斯特,李秀芝,李莉,等.我国关于护士处方权的研究进展及建议[J].护理研究,2020,34(1):101-104.DOI:10.12102/j.issn.1009-6493.2020.01.018.
[34] 牛妞,蒋琪霞,董磊,等.抗菌蛋白酶敷料用于感染伤口的研究进展[J].护理学报,2017,24(24):27-30.DOI:10.16460/j.issn1008-9969.2017.24.027.

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