社區(qū)糖尿病高危足足部管理最佳證據(jù)總結(jié)及證據(jù)可用性評價

魏婷 王靜 胡雁 劉麗敏

Summaryofbestevidenceandevaluationofevidenceavailabilityformanagementofhighriskdiabeticfootpatientsincommunities

WEITing，WANGJing，HUYan，LIULiminSchoolofMedicine，TongjiUniversity，Shanghai200092ChinaCorrespondingAuthorWANGJing，Email：840518242@qq.com

AbstractObjective：Toretrieve，evaluate，andsummarizethebestevidenceonfootmanagementforhighriskdiabeticfootpatientsinthecommunityandevaluatetheevidenceavailability，soastoprovideanevidencebasedbasisforfootmanagementofhighriskdiabeticfootpatientsinthecommunity.Methods：Basedonthe"6S"model，evidenceonfootmanagementforhighriskdiabeticfootpatients，includingclinicaldecisionmaking，guidelines，recommendedpractices，systematicreviews，expertconsensus，andevidencesummaries，wereretrievedsystematicallyfromdatabasesinChinaandforeigncountries.ThesearchtimelimitwasfromtheestablishmentofthedatabasetoOctober31，2022.AccordingtotheevaluationstandardsestablishedbytheClinicalResearchandEvaluationSystem（AGREEⅡ）andtheAustralianJoannaBriggsInstitute（JBI）EvidenceBasedHealthCareCenter（2016），tworesearchersindependentlyassessedthequalityoftheliterature，extractedevidencefromtheliteraturethatmetthequalitystandards，completedtheevidencegradingusingthe2014versionoftheJBIevidencepregradingsystem，andscreenedouttheevidenceavailableinthecommunityusingtheevidenceavailabilityassessment.Results：Atotalof16articleswereincluded，including7guidelines，2expertconsensusarticles，5systematicreviews，1clinicaldecisionmakingarticle，and1evidencesummary.Atotalof40bestpiecesofevidencein11aspectsweresummarized，includingfootscreening，multidisciplinarymanagement，exerciseassessment，exercisepurpose，exercisemethodsandeffects，exercisetimeandfrequency，exerciseintensity，footcare，wearingshoesandsocks，foothealtheducation，andfollowupmonitoring.Finally，37piecesofevidencesuitableforcommunitytransformationwereselected.Conclusions：Thisstudysummarizesthebestevidenceonmanaginghighriskdiabeticfeetandfullyconsideredthecommunitycontexttoevaluatetheavailabilityofevidence.Itcanprovideareferenceformanaginghighriskdiabeticfootinthecommunityandlaythefoundationforevidencetransformation.

Keywordshighriskdiabeticfoot;diabeticperipheralneuropathy;diabeticperipheralarterialdisease;management;exercise;evidencesummary;evidencebasednursing;evidenceavailabilityevaluation

摘要目的：檢索、匯總、評價社區(qū)糖尿病高危足足部管理最佳證據(jù)并進行證據(jù)可用性評價，為社區(qū)糖尿病高危足人群足部管理提供循證依據(jù)。方法：按“6S”模型系統(tǒng)檢索國內(nèi)外數(shù)據(jù)庫關(guān)于糖尿病高危足人群足部管理的證據(jù)，包括臨床決策、指南、推薦實踐、系統(tǒng)評價、專家共識及證據(jù)總結(jié)，檢索時限為建庫至2022年10月31日。2位研究者負責(zé)獨立評估文獻質(zhì)量，借鑒臨床實踐指南研究與評價系統(tǒng)（AGREEⅡ）與澳大利亞JoannaBriggsInstitute（JBI）循證衛(wèi)生保健中心確立的評估標(biāo)準（2016），對符合質(zhì)量標(biāo)準的文獻開展證據(jù)提取，并借助2014版JBI證據(jù)預(yù)分級系統(tǒng)完成證據(jù)分級。通過證據(jù)可用性評價篩選出社區(qū)情景下可用的證據(jù)。結(jié)果：共納入16篇文獻，包含7篇指南、2篇專家共識、5篇系統(tǒng)評價、1篇臨床決策與1篇證據(jù)總結(jié)，歸納了足部篩查、多學(xué)科管理、運動評估、運動目的、運動方式及效果、運動時間及頻率、運動強度、足部護理、鞋襪穿著、足部健康教育、隨訪監(jiān)測11個方面共40條最佳證據(jù)，最終篩選出37條符合社區(qū)轉(zhuǎn)化的證據(jù)。結(jié)論：本研究總結(jié)了糖尿病高危足足部管理的最佳證據(jù)，并充分考慮社區(qū)情境下證據(jù)可用性，對社區(qū)糖尿病高危足管理具有指導(dǎo)作用，為證據(jù)轉(zhuǎn)化奠定基礎(chǔ)。

關(guān)鍵詞糖尿病高危足;糖尿病周圍神經(jīng)病變;糖尿病外周動脈病變;管理;運動;證據(jù)總結(jié);循證護理;證據(jù)可用性評價

doi：10.12102/j.issn.20958668.2024.09.001

糖尿病高危足為糖尿病足的前期狀態(tài)。國際糖尿病足工作組（InternationalWorkingGroupontheDiabeticFoot，IWGDF）2015年關(guān)于糖尿病高風(fēng)險足潰瘍病人預(yù)防足潰瘍指南中給出的定義是：“糖尿病病人中未出現(xiàn)活動性足潰瘍，但發(fā)生了周圍神經(jīng)病變，或伴發(fā)周圍血管病變或足畸形，或存在足潰瘍或截肢史的病人［1］?！?br>