基于流程管理的成人体外膜肺氧合最佳证据总结

Summary of the Best Evidence for Adult ECMO Based on Process Management

摘要: 目的：检索体外膜肺氧合技术流程管理的相关证据，总结体外膜肺氧合技术流程管理的最佳证据，为临床提供体外膜肺氧合治疗期间管理的循证依据。方法：检索国内外相关数据库和相关组织、指南网站中有关体外膜肺氧合技术流程管理的所有证据，证据类型包括指南、专家共识、系统评价、Meta分析。检索时限为2012年11月31日至2022年11月31日，由2名研究者对检索到的证据进行独立的文献质量评价，结合业内专家的意见，对符合质量标准的文献进行证据提取及总结。结果：初步检索共获得文献1347篇，最终纳入12篇文献，包括4篇指南、7篇专家共识、1篇Meta分析，从体外膜肺氧合的适应症和禁忌症、抗凝监测、运行期间指标监测、护理、并发症的预防和处理、镇静镇痛、营养支持、早期康复、团队管理和撤机10个方面汇总38条最佳证据。结论：体外膜肺氧合技术流程管理的最佳证据总结能够为有效促进患者康复提供理论依据，在实际应用过程中，应注意与临床情境和患者病情选择最佳证据，以形成科学、有循证依据的体外膜肺氧合管理方案，从而加速患者康复，提升危重患者救治质量。

Abstract: Objective: Search the relevant evidence of ECMO process management, summarize the best evidence of ECMO process management, and provide clinical evidence-based basis for the management during ECMO treatment. Methods: All evidence on the process management of ECMO technology in domestic and foreign relevant databases and relevant organizations and guideline websites were searched, and the types of evidence included guidelines, expert consensus, systematic evaluation, and Meta-analysis. The retrieval period is from November 31, 2012 to November 31, 2022. Two researchers will independently evaluate the literature quality of the retrieved evidence, and, combined with the opinions of experts in the industry, will extract and summarize the literature that meets the quality standards. Results: The preliminary search obtained 1347 articles, which included 12 articles, including 4 guidelines, 7 expert consensuses and 1 meta-analysis, and summarized 38 best evidence from 10 aspects of indications and contraindications for ECMO, anticoagulant monitoring, index monitoring during operation, nursing, prevention and management of complications, sedation and analgesia, nutritional support, early rehabilitation, team management and withdrawal. Conclusion: ECMO technology process management of the best evidence summary can provide theoretical basis for effectively promoting patient rehabilitation. In the actual application process, we should pay attention to selecting the best evidence with clinical situation and patients’ condition, so as to form a scientific and evidence-based ECMO management scheme, thus accelerating patients’ rehabilitation and improving the quality of treatment for critically ill patients.