作者：王畅1 ，王飞2 ，朱宁宁1 ，林昕3 ，王琳4 ，蔡维维5

单位：

1.233030安徽省蚌埠市，蚌埠医科大学护理学院　2.233099安徽省蚌埠市第三人民医院护理部　3.233099安 徽省蚌埠市第三人民医院老年医学科　4.233099安徽省蚌埠市第三人民医院心血管内科　5.233099安徽省蚌埠市第三 人民医院重症医学科

Units：

1.School of Nursing, Bengbu Medical University, Bengbu 233030, China 2.Department of Nursing, Bengbu Third People's Hospital, Bengbu 233099, China 3.Department of Geriatrics, Bengbu Third People's Hospital, Bengbu 233099, China 4.Department of Cardiology, Bengbu Third People's Hospital, Bengbu 233099, China 5.Department of Critical Care Medicine, Bengbu Third People's Hospital, Bengbu 233099, China

关键词：

冠心病；老年人；经皮冠状动脉介入治疗；饮食管理；循证医学；证据

Keywords：

Coronary disease; Aged; Percutaneous coronary intervention; Dietary management; Evidence-based medicine; Evidence

CLC：

R 541.4

DOI：

10.12114/j.issn.1008-5971.2024.00.015

Funds：

安徽省卫生健康科研项目（AHWJ2022c016）；蚌埠医学院研究生科研创新计划项目（Byycxz22040）

摘要：

目的　总结老年冠心病患者经皮冠状动脉介入治疗（PCI）后饮食管理的最佳证据。方法　按照 “6S”金字塔证据模型检索BMJ Best Practice、UpToDate、澳大利亚乔安娜布里格斯研究所（JBI）循证卫生保健中 心、英国国家卫生与临床优化研究所（NICE）网站、苏格兰院际指南网（SIGN）网站、加拿大安大略省注册护士协 会（RNAO）网站、国际指南协作网（GIN）网站、美国心脏协会（AHA）网站、美国心脏病学会（ACC）网站、欧 洲心脏协会（ESC）网站、Cochrane Library、PubMed、Medline、Web of Science、Embase、卫生保健及护理学数据库 （CINAHL）、医脉通、中国知网、中国生物医学文献数据库、万方数据知识服务平台、维普网公开发表的老年冠心 病患者PCI后饮食管理的证据相关文献。检索时限为建库至2023年3月。由2名研究人员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16篇，其中6篇指南、5篇专家共识、2篇系统评价、2篇 临床决策、1篇证据总结。纳入的6篇指南中，3篇的推荐级别为A级，3篇的推荐级别为B级；纳入的5篇专家共识的条 目1～5均为“是”，条目6均为“否”；纳入的2篇系统评价的所有条目为“是”；纳入的2篇临床决策引用的证据均 为本研究已经纳入的指南和专家共识，纳入的1篇证据总结来自澳大利亚JBI循证卫生保健中心，因质量较高，直接引 用其证据及分级。通过对纳入证据内容进行翻译、汇总和整理，最终形成了老年冠心病患者PCI后饮食管理的最佳证 据，包括干预团队、饮食和营养评估、体质量管理、饮食结构、饮食建议、饮食模式、运动管理、饮食指导8个方面 共35条证据。结论　本研究总结了老年冠心病患者PCI后饮食管理的最佳证据，包括干预团队、饮食和营养评估、体 质量管理、饮食结构、饮食建议、饮食模式、运动管理、饮食指导8个方面共35条证据。在应用证据时，医护人员应 结合具体的临床情景为患者提供科学的饮食管理计划，以提高患者的饮食自我管理能力，改善患者的预后。

Abstract：

Objective To summarize the best evidence of dietary management in elderly patients with coronary heart disease after percutaneous coronary intervention (PCI) . Methods According to the "6S" evidence-based resource pyramid model, the literature on the evidence of dietary management in elderly in patients with coronary heart disease after PCI published in BMJ Best Practice, UpToDate, Joanna Briggs Institute (JBI) Centre for Evidence-Based Health Care in Australia, National Institute for Health and Clinical Excellence (NICE) website, Scottish Intercollegiate Guidelines Network (SIGN) website, Registered Nurses' Association of Ontario (RNAO) website, Guideline International Network (GIN) website, American Heart Association (AHA) website, American College of Cardiology (ACC) website, European Society of Cardiology (ESC) website, Cochrane Library, PubMed, Medline, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) , Medlive, CNKI, China Biomedical Literature Database, Wanfang Data, VIP were searched. The search time was from inception of the database to March 2023. Two researchers evaluated the quality of the included literature, conducted literature screening and content extraction, evidence extraction and evidence level evaluation. Results A total of 16 literature were included, including 6 guidelines, 5 expert consensus, 2 systematic evaluations, 2 clinical decisions, and 1 evidence summary. Among the 6 guidelines, 3 guidelines had a recommendation level of A, and 3 guidelines had a recommendation level of B. Item 1-5 of the 5 expert consensus were evaluated as "yes" , item 6 was evaluated as "no" . All items of 2 systematic evaluations were evaluated as "yes" . The cited evidences of 2 clinical decisions were based on the guidelines and expert consensus already included in this study. One evidence summary was from the JBI Centre for Evidence-Based Health Care in Australia, with high quality, directly citing its evidence and grading. Through translating, summarizing, and organizing the included evidence content, the best evidence of dietary management in elderly patients with coronary heart disease after PCI including 35 items in 8 aspects of intervention team, diet and nutritional assessment, body mass management, dietary structure, dietary recommendations, dietary patterns, exercise management, and dietary guidance. Conclusion This study summarizes the best evidence of dietary management in elderly patients with coronary heart disease after PCI, it includs 35 items in 8 aspects of intervention team, diet and nutritional assessment, body mass management, dietary structure, dietary recommendations, dietary patterns, exercise management, and dietary guidance. When the evidence is applied, healthcare professionals should provide a scientific dietary management plan for the patients combining specific clinical scenarios inorder to improve their dietary self-management and improve their prognosis.

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