预防老年髋部骨折患者围手术期谵妄的最佳证据总结

目的 基于循证的方法和要求,遴选获取国内外老年髋部骨折患者围手术期谵妄预防的相关证据,并对最佳证据进行总结。方法 系统检索Joanna Briggs Institute（JBI）循证卫生保健中心数据库、美国国立指南数据库、英国国家医疗保健优化研究所指南库、加拿大安大略护理学会网站、Up to Date、Cochrane Database、PubMed、澳大利亚和新西兰老年医学会网站、美国麻醉护士学会网站、欧洲麻醉学会网站、印度精神病学会网站、美国骨科医师学会网站、欧洲创伤和急诊外科学会网站、万方医学网、中国生物医学文献数据库等国内外数据库,检索时限为2014年1月至2019年3月。分别采用AGREE Ⅱ评分、系统综述评价工具、JBI（2016）对纳入的临床实践指南、系统评价、专家共识进行2人独立文献质量评价,结合专业人员判断,对符合标准的文献进行资料提取。结果 共纳入9篇文献,其中临床实践指南4篇,系统评价2篇,最佳实践建议1篇,专家共识2篇。从谵妄危险因素评估、谵妄筛查、谵妄预防、患者及家属健康教育、医务工作者培训及评价等6个方面汇总最佳证据共13条。结论 骨科医护人员应接受谵妄预防知识培训,选择结构化的工具进行谵妄风险因素评估,定期进行谵妄筛查。证据应用人员需结合医院及临床实际,选择合适的最佳证据,降低老年髋部骨折患者术后谵妄发生率。

A best-evidence summary of prevention strategies for perioperative delirium in elderly patients with hip fractures

Objective According to evidence-based methods and requirements,to summarize the best evidence for prevention of perioperative delirium in elderly patients with hip fractures. Methods The domestic and foreign databases such as JBI,NGC,NICE,RNAO,Up to Date,Cochrane Database,PubMed,ANZSGM,ASPN,ESA,IDP,AAOS,ESTES,Wanfang were searched. The publication time of literature was from January 2014 to March 2019. Two researchers independently appraised articles,and extracted data for eligible studies according to the judgment of professionals. Results A total of 9 related articles were enrolled,including 4 clinical practice guidelines,2 systematic reviews,2 expert consensuses and 1 best practice recommendation. Totally 13 items of best evidence were summarized from six aspects：assessment of delirium risk factors,delirium screening,delirium prevention,patient and family health education,medical worker training and evaluation. Conclusion Medical staff should receive regular training on delirium prevention,and select structured tools for delirium risk assessment. Before application,best evidence should be selected according to the environment and characteristics of the hospital to reduce the incidence of postoperative delirium in elderly patients with hip fracture.