建立下肢靜脈性潰瘍病人臨床照護指引Developing Clinical Practice Guidelines for Patients with Venous Leg Ulcers in Taiwan

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2018-12-11 已刊登
新刊登 綜 整 綜合類型

作  者

林筱青 許晉豪 方前量 陳威臣 陳坤翰 蘇育敏 張簡志炫 楊正三 吳依璇 范君瑜*

實證知識類別

C 類:實證健康照護指引

PICO

綜合型

治療/介入措施

皮膚系統 Dermatology

科別

  • 傷口照護/造口/失禁照護護理 Wound Care / Ostomy / Continence Care Nursing
  • 臨床指引/實證照護成效 Clinical Guidelines/Evidence Based Outcomes

中文關鍵詞

下肢靜脈性潰瘍 照護指引

英文關鍵詞

venous leg ulcers clinical guidelines

機構名稱

戴德森醫療財團法人嘉義基督教醫院

申請單位

外科部整形外科傷口照護中心

中文摘要

靜脈性下肢潰瘍(Venous Leg Ulcers, VLUs)為慢性傷口的一種,約有45%持續時間超過十年,導致慢性疼痛、行動不便、社交孤立和日常生活活動受限,對病人的生活品質有顯著的影響。當傷口癒合後,因病患本身的靜脈功能不全和靜脈高壓等問題,第一年有28%VLUs的復發的機會,五年內復發率高達76%。目前國內現有VLUs相關研究不多且無臨床照護指引,故引發我們建立符合國情之本土化VLUs臨床照護指引,本文依照The Appraisal of Guideline for Research & Evaluation (AGREE)臨床指引評估工具之四個階段建置,第一階段訂定指引之適用範圍與目的及涵蓋的臨床問題。第二階段以系統性方法搜尋2018年9月6日以前實證等級較高之文獻,經過篩選確定收錄文獻有46篇其中有3篇臨床照護指引、19篇系統性文獻回顧及統合分析和24篇隨機臨床試驗,依分類實證等級,並綜整文獻內容。第三階段進行嚴謹評讀分析及證據萃取上述研究結果後,建構照護指引的草稿,內容涵蓋七個構面共43項,包括評估2項、診斷2項、感染控制6項、壓力治療3項、傷口照護8項、手術治療5項及輔助治療17項。第四階段以邀請南部某教學醫院具照護VLUs實務經驗之整形外科及心臟血管外科醫護專家共25人,包括醫師10人、專科護理師9人、護理長2人及傷口護理師4人,以專家焦點團體會議及照護指引的可行性進行問卷調查,進行指引草案討論、專家內容效度檢定及對指引實施可行性之意見,經多次修正後建立高實證等級且符合本國國情文化之「VLUs病人臨床照護指引」,建立的指引內容涵蓋七個構面共22項,包括評估2項、診斷1項、感染控制4項、壓力治療2項、傷口照護5項、手術治療2項及輔助治療6項,納入實證強度Level I及 Grade A之文獻皆為實證等級較高之研究。本指引建立可提供醫護人員照護VLUs病人之參考,作為臨床照護最佳證據等級實務之依據,以提升VLUs照護的品質。

英文摘要

Venous leg ulcers (VLUs) are a type of chronic wounds. About 45% of them last for more than 10 years, cause chronic pain, limited mobility, social isolation, limited daily activities, and significantly affecting patients’ quality of life. Even the wounds heal, the recurrence rate are 28 % during the first year and 76% within the five years, respectively for the patients with venous insufficiency and venous hypertension. There are no standard care guidelines for VLUs in Taiwan, thus why motives us to develop the VLUs clinical practice guidelines. This article is based on the four stages of the Appraisal of Guideline for Research & Evaluation (AGREE). The first stage established the scope and purpose of the guidelines and the covered clinical issues. Second, a systematic review method was used to search literature with higher strength of evidence that published before September 6, 2018. Forty-six articles were analyzed which included 3 clinical practice guidelines, 19 systematic reviews and meta-analysis, and 24 randomized clinical trials. Third, with rigorous review, analysis and evidence extraction, the draft of the practice guidelines was constructed. It comprised 43 items and divided into seven domains: 2 items of assessment, 2 items of diagnosis, 6 items of infection control, 3 items of compression treatment, 8 items of wound care, 5 items of surgical treatment and 17 items of adjuvant treatment. In the fourth stage, 10 clinical doctors, 9 specialist nurses, 2 nursing heads and 4 wound care nurses in a teaching hospital in southern Taiwan were invited for the group meeting and answered the practice guidelines feasibility questionnaire. The final practice guidelines comprised 22 items and were categorized into seven domains: 2 items of assessment, 1 item of diagnosis, 4 items of infection control, 2 items of compression treatment, 5 items of wound care, 2 items of surgical treatment and 6 items of adjuvant treatment. The practice guidelines provide evidence-based recommendations that can improve the quality of care for patients with VLUs.