作者：李彩虹，胡琼燕，蒋建华，雷涛，邓承明，赵露露，王家乐

单位：

1.广西中医药大学护理学院2.广西医学科学院·广西壮族自治区人民医院妇产科3.广西医学科学院·广西壮族自治区人民医院心胸血管外科4.右江民族医学院护理学院

Units：

1.School of Nursing, Guangxi University of Chinese Medicine, Nanning 530200, China 2.Department of Obstetrics, Guangxi Academy of Medical Sciences·the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China 3.Department of Cardiothoracic Surgery, Guangxi Academy of Medical Sciences·the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China 4.School of Nursing, Youjiang Medical University for Nationalities, Baise 533000, China

关键词：

体外循环; 心脏手术; 成年人; 液体管理; 最佳证据;

Keywords：

　Extracorporeal circulation; Cardiac procedures; Adult; Fluid management; Best evidence

CLC：

R 654.1

DOI：

10.12114/j.issn.1008-5971.2023.00.041

Funds：

广西壮族自治区卫生健康委员会自筹经费科研课题（Z-A20220073，Z-A20220075）

摘要：

目的 总结成年体外循环心脏手术患者医护一体化液体管理的最佳证据。方法 按照“6S”金字塔证据模型，系统检索BMJ Best Practice、UpToDate、国际指南协作网（GIN）、苏格兰院际指南网（SIGN）、美国国立指南库（NGC）、英国国家卫生与临床优化研究所（NICE）网站、加拿大安大略省注册护士协会（RNAO）网站、医脉通指南网、澳大利亚乔安娜布里格斯研究所（JBI）循证卫生保健中心数据库、Cochrane Library、Web of Science、PubMed、Embase、中国生物医学文献数据库（CBMdisc）、维普中文期刊服务平台、中国知网、万方数据知识服务平台公开发表的体外循环心脏手术患者液体管理相关文献，并手动检索相关文献的参考文献，检索时间为建库至2022-05-31。由2名研究人员根据文献的纳入和排除标准及文献质量评价结果进行文献筛选及内容提取。采用内容分析法，从最终纳入的文献中提取与本研究相关的证据，并进行证据整合，同时评估最佳证据的等级、推荐级别。结果 最终共纳入15篇文献，其中专家共识4篇、指南3篇、临床决策3篇、系统评价3篇、最佳实践1篇、Meta分析1篇。4篇专家共识经小组讨论后均纳入本研究；3篇指南的推荐级别均为A级；追溯3篇临床决策的原始文献，其提取的证据分别来源于2篇指南、1篇专家共识，其质量评价结果均较好；3篇系统评价和1篇Meta分析的质量评价结果均≥10分；追溯1篇最佳实践的原始文献，其提取的证据分别来源于1篇指南和1篇系统评价，其质量评价结果均较好。通过证据提取与整合，最终形成了成年体外循环心脏手术患者医护一体化液体管理的最佳证据，其包含6个类别，共20条证据。结论本研究总结了6个类别共20条成年体外循环心脏手术患者医护一体化液体管理的最佳证据，包括多学科团队协作、动态评估和监测液体状态、早期液体复苏、早期正确使用正性肌力药物和血管活性药物、根据患者病情合理使用利尿剂、采用目标导向性治疗（GDT）策略指导个体化液体管理，为目前临床上体外循环心脏手术患者术后液体管理提供了思路与参考。

Abstract：

Objective To summarize the best evidence of integrated medical care fluid management for adult patients undergoing cardiopulmonary bypass cardiac surgery. Methods According to the "6S" pyramid evidence model, literature on fluid management in patients undergoing cardiopulmonary bypass cardiac surgery publicly published by BMJ Best Practice, UpToDate, Guideline International Network (GIN) , Scottish Intercollegiate Guidelines Network (SIGN) , National Guideline Clearinghouse (NGC) , National Institute for Health and Care Excellence (NICE) website, Registered Nurses' Association of Ontario (RNAO) website, Chinese Guideline Network, Joanna Briggs Institute (JBI) Evidence-based Health Care Center in Australia, Cochrane Library, Web of Science, PubMed, Embase, China Biology Medicine disc (CBMdisc) , VIP, CNKI and Wanfang Data were systematically retrieved, and the references of related literature were manually supplemented. The retrieval time was from the establishment of database to 2022-05-31. Literature screening and content extraction were conducted by two researchers according to the inclusion and exclusion criteria and the results of literature quality evaluation. Content analysis method was adopted to extract evidence related to this study from the final included literature, and the evidences were integrated, and the level and recommendation level of best evidence were evaluated. Results A total of 15 articles were included, including 4 expert consensus, 3 guidelines, 3 clinical decision-making, 3 systematic reviews, 1 best practice and 1 meta-analysis. Four expert consensus were included in this study after group discussion. The recommended level of the three guides was grade A. The original documents of 3 clinical decisions were traced back, and the evidence extracted was from 2 guides and 1 expert consensus respectively, and the quality evaluation results were all good. The quality evaluation results of 3 systematic reviews and 1 meta-analysis were all ≥ 10 points. The original literature of 1 best practice were traced back, the evidence extracted was from 1 guideline and 1 systematic review, and the quality evaluation results of them were both good. Through evidence extraction and integration, the best evidence of integrated medical care fluid management for adult patients undergoing cardiopulmonary bypass cardiac surgery was finally formed, including 6 categories and 20 pieces of evidence. Conclusion This study summarizes the best evidence of integrated medical care fluid management for adult patients undergoing cardiopulmonary bypass cardiac surgery with a total of 20 guidelines in 6 categories, including multidisciplinary team collaboration, dynamic assessment and monitoring of fluid status, early fluid resuscitation, early correct use of positive and vasoactive drugs, rational use of diuretics according to patients' conditions, and the use of target-oriented therapy (GDT) strategy to guide individual fluid management. It provides ideas and references for the current clinical postoperative fluid management of patients undergoing cardiopulmonary bypass surgery.

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