作者：肖倩 ，温绣蔺，胡晓红，韩梅，崔延超，汪静容，罗利群 ，苏留菊

单位：

1.712046陕西省咸阳市，陕西中医药大学护理学院　2.710061陕西省西安市，西安交通大学第一附属医院护理部　 3.710061陕西省西安市，西安交通大学第一附属医院康复医学科　4.710032陕西省西安市，空军军医大学第二附属医院手术室

关键词：

脑卒中；偏瘫；良肢位摆放；循证医学；证据

Keywords：

Stroke; Hemiplegia; Good limb positioning; Evidence-based medicine; Evidence

CLC：

R 743.3

DOI：

10.12114/j.issn.1008-5971.2023.00.249

Funds：

国家卫生健康委医院医疗质量（循证）管理研究项目（YLZLXZ23G009）；陕西省重点研发计划项目（2022SF- 581）

摘要：

目的　总结脑卒中偏瘫患者良肢位摆放的最佳证据。方法　按照“6S”循证资源金字塔证据模型，计 算机检索BMJ Best Practice、澳大利亚乔安娜布里格斯研究所（JBI）循证卫生保健中心网站、UpToDate、国际指南协 作网（GIN）、苏格兰院际指南网（SIGN）、英国国家卫生与临床优化研究所（NICE）网站、美国医疗保健研究与质 量局（AHRQ）网站、加拿大安大略省注册护士协会（RNAO）网站、Cochrane Library、Embase、PubMed、万方数据 知识服务平台、中国知网、维普网、中国生物医学文献数据库、医脉通等网站或数据库中关于脑卒中偏瘫患者良肢位 摆放的文献，检索时限为2015年1月至2023年6月。由两名研究者独立进行文献筛选及内容提取、文献质量评价、证据 提取与证据等级评价。结果　共纳入文献9篇，包括指南6篇、证据总结2篇、系统评价1篇。6篇指南中，4篇的推荐级 别为A级，2篇的推荐级别为B级。2篇证据总结中，李佳梅等研究的条目7为“否”、条目10为“部分是”，陈煌等研 究的条目1为“否”、条目3为“部分是”，其余条目均为“是”。1篇系统评价的条目2为“部分是”，其余条目均为 “是”。通过对纳入证据内容进行翻译、汇总和整理，最终形成了脑卒中偏瘫患者良肢位摆放的最佳证据，包括良肢 位摆放的重要性、团队成员、摆放前评估、摆放时机、摆放体位、并发症防治、质量控制与评价7个方面24个条目。 结论　该研究总结了包括良肢位摆放的重要性、团队成员、摆放前评估、摆放时机、摆放体位、并发症防治、质量控 制与评价7个方面24个条目的脑卒中偏瘫患者良肢位摆放的最佳证据，为脑卒中偏瘫患者实施科学、规范的良肢位摆 放，改善患者康复效果提供了依据。

Abstract：

Objective To summarize the best evidence of good limb positioning in stroke patients with hemiplegia. Methods According to the "6S" evidence-based resource pyramid model, the literature on good limb positioning in stroke patients with hemiplegia were retrieved from BMJ Best Practice, Joanna Briggs Institute (JBI) Evidence Based Health Care Center website in Australia, UpToDate, Guideline International Network (GIN) , Scottish Intercollegiate Guidelines Network (SIGN) , National Institute for Health and Care Excellence (NICE) website, Agency for Healthcare Research and Quality (AHRQ) website, Registered Nurses' Association of Ontario (RNAO) website, Cochrane Library, Embase, PubMed, Wanfang Data, CNKI, VIP, China Biomedical Literature Database, Medlive. The search period was from January 2015 to June 2023. Two researchers independently selected articles, extracted content evaluated the quality of the literature, extracted evidence, and evaluated the evidence level. Results A total of 9 articles were included, and including 6 guidelines, 2 evidence summaries, and 1 systematic review. Among the 6 guidelines, 4 were grade A recommendations and 2 were grade B recommendations. Among the 2 evidence summaries, in LI Jianmei et al.'s study, item 7 was evaluated as "no" and item 10 was evaluated as "partially yes" , in CHEN Huang et al.'s study, item 1 was evaluated as "no" and item 3 was evaluated as "partially yes" , other items were evaluated as "yes" . In 1 systematic review, item 2 was evaluated as "partially yes" , other items were evaluated as "yes" . Through translating, summarizing, and organizing the included evidence content, the best evidence of good limb positioning in stroke patients with hemiplegia including 24 items in 7 aspects of importance of good limb positioning, team members, pre placement evaluation, placement timing, placement positioning, prevention and treatment of complications, and quality control and evaluation was formed. Conclusion This study summarizes the best evidence of good limb positioning in stroke patients with hemiplegia including 24 items in 7 dimensions of importance of good limb positioning, team members, pre placement evaluation, placement timing, placement positioning, and prevention and treatment of complications，and provides a basis for implementing scientific and standardized good limb positioning in stroke patients with hemiplegia and improving their rehabilitation outcomes.

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