老年皮肤瘙痒症患者非药物管理的最佳证据总结

doi:10.16460/j.issn1008-9969.2024.03.046

摘要/Abstract

摘要： 目的系统检索、评价并综合老年皮肤瘙痒症患者非药物治疗的最佳证据,为临床护理实践提供参考。方法以“6S”证据金字塔为模型进行证据检索,系统检索计算机决策支持系统、指南网站、专业学会网站和数据库中关于老年皮肤瘙痒症非药物治疗的临床决策、指南、证据总结、系统评价、专家共识,检索时限为建库至2023年7月30日。由2名具有循证知识的研究者对纳入的文献进行质量评价,根据主题对证据进行提取、总结。结果最终纳入指南4篇、临床决策3篇、系统评价4篇、专家共识2篇,形成原则、评估、物理治疗、中医治疗、心理治疗、健康宣教6个主题,共22条最佳证据。结论该研究总结了老年皮肤瘙痒症患者非药物治疗的最佳证据,为临床护理实践提供了依据。护理人员可结合临床实际情境进行证据应用,加强对老年皮肤瘙痒症患者的科学管理。

关键词: 老年皮肤瘙痒症, 非药物管理, 证据总结, 循证护理

Abstract: Objective To systematically search, evaluate and synthesize the best evidence for non-pharmacological treatment of pruritus in elderly patients, and provide reference for clinical nursing practice. Methods Evidence retrieval was conducted following the “6S” pyramid model. Computer decision support systems, guidelines websites, professional association websites and databases were systematically searched for clinical decisions, guidelines, evidence summaries, systematic reviews and expert consensus on non-pharmacological treatment of pruritus in elderly patients. The retrieval period ranged from the inception to July 30, 2023. Two researchers with evidence-based knowledge evaluated the quality of the included literature, and extracted and summarized the evidence according to themes. Results A total of 4 guidelines, 3 clinical decisions, 4 systematic reviews and 2 expert consensuses were finally included, forming 6 themes of principles, assessment, physical therapy, Chinese medicine therapy, psychological therapy and health education, with 22 pieces of best evidence. Conclusion This study summarizes the best evidence for non-pharmacological treatment of pruritus in elderly patients, providing a basis for clinical nursing practice. Nursing staff can apply the evidence in combination with actual clinical contexts to strengthen scientific management of pruritus in elderly patients.

Key words: pruritus in elderly patient, non-pharmacological treatment, evidence summary, evidence-based nursing

中图分类号:

R473.59

祁水林, 林桦, 邓锐颖, 李荣杰, 李若雨, 王凤廷. 老年皮肤瘙痒症患者非药物管理的最佳证据总结[J]. 护理学报, 2024, 31(3): 46-50.

QI Shui-lin, LIN Hua, DENG Rui-ying, LI Rong-jie, LI Ruo-yu, WANG Feng-ting. Best evidence summary for non-pharmacological treatment of pruritus in elderly patients[J]. Journal of Nursing, 2024, 31(3): 46-50.

参考文献

[1] 中国中西医结合学会皮肤性病专业委员会老年皮肤病学组. 老年皮肤瘙痒症诊断与治疗专家共识[J]. 中国皮肤性病学杂志, 2018, 32(11):1233-1237. DOI:10.13735/j.cjdv.1001-7089.201808168.
[2] 陈师, 高静, 柏丁兮, 等. 中国老年性皮肤瘙痒症患病率的Meta分析[J]. 中国循证医学杂志, 2020, 20(5):562-567. DOI:10.7507/1672-2531.201910023.
[3] Norman RA.Xerosis and pruritus in the elderly: recognition and management[J]. Dermatol Ther, 2003, 16(3):254-259. DOI:10.1046/j.1529-8019.2003.01635.x.
[4] 唐桦. AQP3在不同年龄段正常人皮肤组织及角质形成细胞、成纤维细胞中的表达[D]. 长沙:中南大学,2008.
[5] 张子衿, 祝钧, 孟宏, 等. 老年性瘙痒症发病机制研究进展[J]. 中国老年学杂志, 2018, 38(18):4598-4600. DOI:10.3969/j.issn.1005-9202.2018.18.087.
[6] Valdes-Rodriguez R, Stull C,Yosipovitch G.Chronic pruritus in the elderly: pathophysiology, diagnosis and management[J]. Drugs Aging, 2015, 32(3):201-215. DOI:10.1007/s40266-015-0246-0.
[7] van Os-Medendorp H, Ros WJ, Eland-de Kok PC, et al. Effectiveness of the nursing programme ‘Coping with itch’: a randomized controlled study in adults with chronic pruritic skin disease[J]. Br J Dermatol, 2007, 156(6):1235-1244. DOI:10.1111/j.1365-2133.2007.07919.x.
[8] 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.
[9] DiCenso A, Bayley L, Haynes RB. ACP Journal Club. Editorial: accessing preappraised evidence: fine-tuning the 5S model into a 6S model[J]. Ann Intern Med, 2009, 151(6):JC3-2,JC3-3.DOI:10.7326/0003-4819-151-6-200909150-02002.
[10] AGREE Next Steps Consortium. The AGREE II Instrument.[EB/OL].(2017-11-30)[2022-11-28].https://www.agreetrust.org/wp-content/uploads/2017/12/AGREE-II-Users-Manualand-23-item-Instrument-2009-Update-2017.pdf.
[11] 胡雁,郝玉芳.循证护理学[M].北京:人民卫生出版社,2018.
[12] 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.
[13] Satoh T, Yokozeki H, Murota H, et al.2020 guidelines for the diagnosis and treatment of cutaneous pruritus[J]. J Dermatol, 2021, 48(9):e399-e413.DOI:10.1111/1346-8138.16066.
[14] 中国医师协会皮肤科分会变态反应性疾病专业委员会. 慢性瘙痒管理指南(2018版)[J]. 中华皮肤科杂志, 2018, 51(7):481-485. DOI:10.3760/cma.j.issn.0412-4030.2018.07.001.
[15] Weisshaar E, Szepietowski JC, Dalgard FJ, et al.European S2k guideline on chronic pruritus[J]. Acta Derm Venereol, 2019, 99(5):469-506. DOI:10.2340/00015555-3164.
[16] Chinniah N, Gupta M.Pruritus in the elderly-a guide to assessment and management[J].Aust Fam Physician, 2014, 43(10):710-713.
[17] Fazio SB, Yosipovitch G, Dellavalle RP, et al. Pruritus: etiology and patient evaluation[EB/OL].(2022-3-27)[2023-6-1].http://update.0013.isus.top/contents/pruritus-etiology-and-patient-evaluation.pdf.
[18] Dardier Hussein Awad R, Awad Mekhamier H, Abou Elazayiem Bayumi H, et al. Effect of nursing guidelines about pruritus on patients with skin diseases[J]. Egyptian Journal of Health Care, 2022, 13(3):1014-1032.
[19] Fazio SB, Yosipovitch G, Callen J. Pruritus: therapies for localized pruritus[EB/OL]. (2021-7-7)[2023-6-1]. https://www.uptodate.cn/contents/zh-Hans/pruritus-etiology-and-patient-evaluation.pdf.
[20] Andrade A, Kuah CY, Martin-Lopez JE, et al. Interventions for chronic pruritus of unknown origin[J]. Cochrane Database Syst Rev, 2020, 1(1):CD013128. DOI:10.1002/14651858.CD013128.pub2.
[21] Clerc CJ, Misery L.A literature review of senile pruritus: from diagnosis to treatment[J]. Acta Derm Venereol, 2017, 97(4):433-440. DOI:10.2340/00015555-2574.
[22] Chung BY, Um JY, Kim JC, et al.Pathophysiology and treatment of pruritus in elderly[J]. Int J Mol Sci, 2020, 22(1):174. DOI:10.3390/ijms22010174.
[23] Garibyan L, Chiou AS, Elmariah SB.Advanced aging skin and itch:addressing an unmet need[J].Dermatol Ther, 2013, 26(2):92-103. DOI:10.1111/dth.12029.
[24] 中国中西医结合学会皮肤性病专业委员会老年皮肤病学组. 老年皮肤瘙痒症诊断与治疗专家共识[J]. 中国皮肤性病学杂志, 2018,32(11):1233-1237.DOI:10.13735/j.cjdv.1001-7089.201808168.
[25] 中华中医药学会皮肤科分会. 皮肤瘙痒症中医治疗专家共识[J]. 中国中西医结合皮肤性病学杂志, 2017, 16(2):189-190. DOI:10.3969/j.issn.1672-0709.2017.02.036.
[26] 林晓露, 周春兰, 杨玲莉, 等. 尿毒症患者皮肤瘙痒管理的最佳证据总结[J]. 护理学报, 2022, 29(17):38-42. DOI:10.16460/j.issn1008-9969.2022.17.038.
[27] 戴付敏, 王丽君, Christine Behm, 等. 国外老年人皮肤干燥评估与干预的研究进展[J]. 中华护理杂志, 2017, 52(1):53-58. DOI:10.3761/j.issn.0254-1769.2017.01.011
[28] Bressler R, Bahl JJ.Principles of drug therapy for the elderly patient[J]. Mayo Clin Proc, 2003, 78(12):1564-1577. DOI:10.4065/78.12.1564.
[29] 许文斌, 于建春, 温明菲, 等. 针刺配合窄谱中波紫外线照射治疗老年性皮肤瘙痒症38例[J]. 中国针灸, 2018, 38(12):1277-1278,1292. DOI:10.13703/j.0255-2930.2018.12.007.
[30] 李曼, 李华特, 陈晨, 等. 行为习惯逆转疗法结合家属参与健康教育模式在老年瘙痒症病人护理中的应用[J]. 护理研究,2020,34(24):4374-4378.DOI:10.12102/j.issn.1009-6493.2020.24.011.
[31] Weisshaar E, Diepgen TL, Luger TA, et al.Pruritus in pregnancy and childhood--do we really consider all relevant differential diagnoses?[J]. Eur J Dermatol, 2005, 15(5):320-331.
[32] Szepietowski JC, Balaskas E, Taube KM, et al.Quality of life in patients with uraemic xerosis and pruritus[J]. Acta Derm Venereol,2011,91(3):313-317.DOI:10.2340/00015555-1075.

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