下肢静脉溃疡患者肢体功能锻炼的最佳证据总结
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摘要
目的总结下肢静脉溃疡患者肢体功能锻炼的最佳证据,为临床实践提供参考。方法计算机检索国内外循证资源及文献数据库中关于下肢静脉溃疡功能锻炼的指南、证据总结、系统评价等证据。结果共纳入4篇指南、1篇系统评价,获取13条最佳证据并归纳为5个方面的推荐意见,分别为功能锻炼、步态评估、患肢抬高、健康教育、多学科合作。结论医护人员可结合下肢静脉溃疡患者的意愿及实际情况,针对性地选择适合证据,规范功能锻炼,提高治疗效果。
Objective To summarize the best evidence of functional exercise for patients with venous leg ulcer,and to provide reference for clinical practice.Methods We searched databases and resources of evidence-based medicine,e.g.BMJ best practice,Registered Nurses′Association of Ontario(RNAO),National Guideline Clearinghouse(NGC),Scottish Intercollegiate Guideline(SIGN),JBI Evidence Summary,Cochrane Library,PubMed,SinoMed and Wound,Ostomy and Continence Nurses Society(WOCN)to collect guidelines,summaries and systematic reviews concerning functional exercise for venous leg ulcers.Results Four guidelines and one systematic review were included.Then we extracted 13 best evidence and categorized into 5dimensions of recommendations,including functional exercise,gait assessment,affected limb elevation,health education,and multi-disciplinary collaboration.Conclusion Healthcare workers should consider patient preference and clinical situation to select reasonable evidence,thus to standardize functional exercise for patients with venous leg ulcers and enhance therapeutic effect.
Objective To summarize the best evidence of functional exercise for patients with venous leg ulcer,and to provide reference for clinical practice.Methods We searched databases and resources of evidence-based medicine,e.g.BMJ best practice,Registered Nurses′Association of Ontario(RNAO),National Guideline Clearinghouse(NGC),Scottish Intercollegiate Guideline(SIGN),JBI Evidence Summary,Cochrane Library,PubMed,SinoMed and Wound,Ostomy and Continence Nurses Society(WOCN)to collect guidelines,summaries and systematic reviews concerning functional exercise for venous leg ulcers.Results Four guidelines and one systematic review were included.Then we extracted 13 best evidence and categorized into 5dimensions of recommendations,including functional exercise,gait assessment,affected limb elevation,health education,and multi-disciplinary collaboration.Conclusion Healthcare workers should consider patient preference and clinical situation to select reasonable evidence,thus to standardize functional exercise for patients with venous leg ulcers and enhance therapeutic effect.
引文
[1]常光其,陈翠菊,陈忠,等.慢性下肢静脉疾病诊断与治疗中国专家共识[J].中华普通外科杂志,2014,29(4):143-151.
[2]中华中医药学会外科分会.下肢慢性溃疡中医循证临床实践指南[J].中国中西医结合外科杂志,2015,10(5):184-188.
[3]王深明,胡作军.中国静脉外科临床研究的现状与发展[C].广州:第二届中国现代医学研究方法暨学科交叉创新研讨会,2008:23-35.
[4]Sinha S,Sreedharan S.Management of venous leg ulcers in general practice-a practical guideline[J].Aust Fam Physician,2014,43(9):594-598.
[5]Registered Nurses′Association of Ontario.Assessment and management of venous leg ulcers[EB/OL].(2014-10-29)[2017-12-07].http://www.nursinglibrary.org/vhl/handle/10755/333380.
[6]O′Brien J,Finlayson K,Kerr G,et al.The perspectives of adults with venous leg ulcers on exercise:an exploratory study[J].J Wound Care,2014,23(10):500-509.
[7]Roaldsen K S,Biguet G,Elfving B.Physical activity in patients with venous leg ulcer-between engagement and avoidance.A patient perspective[J].Clin Rehabil,2011,25(3):275-286.
[8]韦当,王聪尧,肖晓娟,等.指南研究与评价(AGREEⅡ)工具实例解读[J].中国循证儿科杂志,2013,8(4):316-319.
[9]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.
[10]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.
[11]Scottish Intercollegiate Guidelines Network.Management of chronic venous leg ulcers.A national clinical guidelines[EB/OL].(2010-08-29)[2017-12-07].http://www.sign.ac.uk/sign-120-management-of-chronic-venous-legulcers.html.
[12]Australian Wound Management Association.Australian and New Zealand clinical practice guideline for prevention and management of venous leg ulcers[EB/OL].(2012-08-21)[2017-12-07].http://www.woundsaustralia.com.au/publications/2011_awma_vlug.pdf.
[13]O′Donnell T F Jr,Passman M A,Marston W A,et al.Management of venous leg ulcers:clinical practice guidelines of the Society for Vascular Surgery?and the American Venous Forum[J].J Vasc Surg,2014,60(2):3S-59S.
[14]Yim E,Kirsner R S,Gailey R S,et al.Effect of physical therapy on wound healing and quality of life in patients with venous leg ulcers:a systematic review[J].JAMADermatol,2015,151(3):320-327.
[15]刘芯君,李情洁,游进会,等.四层绷带包扎促进下肢静脉性溃疡愈合及压力维持的效果评价[J].护理学杂志,2016,31(1):57-58.
[16]张莹,周文琴.中药熏洗疗法用于慢性下肢溃疡的研究进展[J].护理学杂志,2017,32(24):103-105.
[17]O′Meara S,Cullum N,Nelson E A,et al.Compression for venous leg ulcers[J].Cochrane Database Syst Rev,2012(11):CD000265.
[18]Harlander-Locke M,Lawrence P F,Alktaifi A,et al.The impact of ablation of incompetent superficial and perforator veins on ulcer healing rates[J].J Vasc Surg,2012,55(2):458-464.
[19]薛晴,卜炜琴,冯金娥.下肢静脉溃疡患者运动干预研究进展[J].护理学报,2018,25(2):37-40.
[20]杨牟,张居文.下肢静脉疾病诊断与治疗[M].北京:人民卫生出版社,2013:38-40.
[21]Simka M.Calf muscle pump impairment and delayed healing of venous leg ulcers:air plethysmographic findings[J].J Dermatol,2007,34(8):537-544.
[22]Barwell J R,Taylor M,Deacon J,et al.Ankle motility is a risk factor for healing of chronic venous leg ulcers[J].Phlebology,2001,16(1):38-40.
[23]Kan Y M,Delis K T.Hemodynamic effects of supervised calf muscle exercise in patients with venous leg ulceration:aprospective controlled study[J].Arch Surg,2001,136(12):1364-1369.
[24]World Health Organization.Physical activity[EB/OL].(2017-02-10)[2017-12-07].http://www.who.int/mediacentre/factsheets/fs385/en/.
[25]Dix F P,Reilly B,David M C,et al.Effect of leg elevation on healing venous velocity and ambulatory venous pressure in venous ulceration[J].Phlebology,2005,20(2):87-94.
[26]Van Hecke A,Grypdonck M,Defloor T.A review of why patients with leg ulcers do not adhere to treatment[J].J Clin Nurs,2009,18(3):337-349.
[2]中华中医药学会外科分会.下肢慢性溃疡中医循证临床实践指南[J].中国中西医结合外科杂志,2015,10(5):184-188.
[3]王深明,胡作军.中国静脉外科临床研究的现状与发展[C].广州:第二届中国现代医学研究方法暨学科交叉创新研讨会,2008:23-35.
[4]Sinha S,Sreedharan S.Management of venous leg ulcers in general practice-a practical guideline[J].Aust Fam Physician,2014,43(9):594-598.
[5]Registered Nurses′Association of Ontario.Assessment and management of venous leg ulcers[EB/OL].(2014-10-29)[2017-12-07].http://www.nursinglibrary.org/vhl/handle/10755/333380.
[6]O′Brien J,Finlayson K,Kerr G,et al.The perspectives of adults with venous leg ulcers on exercise:an exploratory study[J].J Wound Care,2014,23(10):500-509.
[7]Roaldsen K S,Biguet G,Elfving B.Physical activity in patients with venous leg ulcer-between engagement and avoidance.A patient perspective[J].Clin Rehabil,2011,25(3):275-286.
[8]韦当,王聪尧,肖晓娟,等.指南研究与评价(AGREEⅡ)工具实例解读[J].中国循证儿科杂志,2013,8(4):316-319.
[9]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.
[10]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.
[11]Scottish Intercollegiate Guidelines Network.Management of chronic venous leg ulcers.A national clinical guidelines[EB/OL].(2010-08-29)[2017-12-07].http://www.sign.ac.uk/sign-120-management-of-chronic-venous-legulcers.html.
[12]Australian Wound Management Association.Australian and New Zealand clinical practice guideline for prevention and management of venous leg ulcers[EB/OL].(2012-08-21)[2017-12-07].http://www.woundsaustralia.com.au/publications/2011_awma_vlug.pdf.
[13]O′Donnell T F Jr,Passman M A,Marston W A,et al.Management of venous leg ulcers:clinical practice guidelines of the Society for Vascular Surgery?and the American Venous Forum[J].J Vasc Surg,2014,60(2):3S-59S.
[14]Yim E,Kirsner R S,Gailey R S,et al.Effect of physical therapy on wound healing and quality of life in patients with venous leg ulcers:a systematic review[J].JAMADermatol,2015,151(3):320-327.
[15]刘芯君,李情洁,游进会,等.四层绷带包扎促进下肢静脉性溃疡愈合及压力维持的效果评价[J].护理学杂志,2016,31(1):57-58.
[16]张莹,周文琴.中药熏洗疗法用于慢性下肢溃疡的研究进展[J].护理学杂志,2017,32(24):103-105.
[17]O′Meara S,Cullum N,Nelson E A,et al.Compression for venous leg ulcers[J].Cochrane Database Syst Rev,2012(11):CD000265.
[18]Harlander-Locke M,Lawrence P F,Alktaifi A,et al.The impact of ablation of incompetent superficial and perforator veins on ulcer healing rates[J].J Vasc Surg,2012,55(2):458-464.
[19]薛晴,卜炜琴,冯金娥.下肢静脉溃疡患者运动干预研究进展[J].护理学报,2018,25(2):37-40.
[20]杨牟,张居文.下肢静脉疾病诊断与治疗[M].北京:人民卫生出版社,2013:38-40.
[21]Simka M.Calf muscle pump impairment and delayed healing of venous leg ulcers:air plethysmographic findings[J].J Dermatol,2007,34(8):537-544.
[22]Barwell J R,Taylor M,Deacon J,et al.Ankle motility is a risk factor for healing of chronic venous leg ulcers[J].Phlebology,2001,16(1):38-40.
[23]Kan Y M,Delis K T.Hemodynamic effects of supervised calf muscle exercise in patients with venous leg ulceration:aprospective controlled study[J].Arch Surg,2001,136(12):1364-1369.
[24]World Health Organization.Physical activity[EB/OL].(2017-02-10)[2017-12-07].http://www.who.int/mediacentre/factsheets/fs385/en/.
[25]Dix F P,Reilly B,David M C,et al.Effect of leg elevation on healing venous velocity and ambulatory venous pressure in venous ulceration[J].Phlebology,2005,20(2):87-94.
[26]Van Hecke A,Grypdonck M,Defloor T.A review of why patients with leg ulcers do not adhere to treatment[J].J Clin Nurs,2009,18(3):337-349.