小儿脊柱裂膀胱功能障碍全生命周期康复护理策略的最佳证据总结

唐鹤淑; 周萍; 朱春勤; 王燕; 李晶; 常宗阁

doi:10.16766/j.cnki.issn.1674-4152.004066

小儿脊柱裂膀胱功能障碍全生命周期康复护理策略的最佳证据总结

doi: 10.16766/j.cnki.issn.1674-4152.004066

唐鹤淑¹,
周萍^1, ,,
朱春勤²,
王燕¹,
李晶³,
常宗阁⁴

1.
江苏省中医院泌尿外科，江苏南京 210029
2.
江苏省中医院护理部，江苏南京 210029
3.
江苏省中医院针灸康复科，江苏南京 210029
4.
澳门科技大学第一附属医院康复科，广东珠海 519000

基金项目:

江苏省中医药局科技项目 MS2023022

江苏省中医药局科技项目 YB201912

江苏省中医院创新发展项目 Y23022

详细信息

通讯作者:
周萍，E-mail：623198510@qq.com

中图分类号: R726.9 R473.72
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- 文章访问数: 11
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- 被引次数: 0
出版历程
- 收稿日期: 2024-06-25
- 网络出版日期: 2025-09-04

Best evidence summary of comprehensive rehabilitation management for pediatric spina bifida with bladder dysfunction throughout the full continuum of care

1.
Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, China

摘要

摘要: 目的系统检索并总结小儿脊柱裂国内外全生命周期康复护理策略的最佳证据，为临床护理决策提供循证依据。方法检索BMJ最佳临床实践、UpToDate、The Cochrane Library、JBI循证卫生保健中心数据库、中国知网、万方等国内外指南网站及数据库中关于小儿脊柱裂膀胱功能障碍全生命周期康复护理的所有证据，包括证据总结、临床指南、专家共识、系统评价等，检索时限为建库至2024年1月，由2名研究者进行独立文献质量评价、证据提取、归纳及汇总。结果共纳入16篇文献，包括6篇临床指南、2篇专家共识和8篇系统评价，从妊娠期及新生儿期、学龄前期及学龄期、青春成长期3个方面提取31条最佳证据。结论应结合临床情境、个人病情和专业意见，选择最佳证据，进行临床转换及决策，以期建立适合我国本土化小儿脊柱裂膀胱功能障碍全生命周期康复护理方案，为本土临床循证提供参考依据及理论指导。
- 小儿脊柱裂 /
- 膀胱功能障碍 /
- 全生命周期康复护理 /
- 证据总结 /
- 循证护理学
Abstract: Objective To systematically summarize the best evidence of comprehensive rehabilitation management for pediatric spina bifida with bladder dysfunction throughout the full continuum of care, thereby providing evidence-based support for clinical nursing. Methods A comprehensive search of international and domestic guideline websites and databases, including the BMJ Best Practice, UpToDate, The Cochrane Library, the JBI Evidence-Based Health Care Center, the Wanfang, and the CNKI Database, was conducted to retrieve all related evidence. This search encompassed evidence summaries, clinical guidelines, expert consensus, and systematic reviews published from database inception to January 2024. Two researchers independently appraised literature quality, extracted, summarized, and synthesized the evidence. Results The final sample comprised 16 articles, including six clinical guidelines, two expert consensus and eight systematic reviews. A total of 31 best evidence items were extracted from three distinct periods of development: pregnancy and neonatal period, the preschool age and school age period, and the adolescent growth period. Conclusion The selection of the most compelling evidence should take into account clinical contexts, individual conditions and professional opinions, with the objective of establishing a localized comprehensive rehabilitation management program for pediatric spina bifida with bladder dysfunction in China.
- Pediatric spina bifida /
- Bladder dysfunction /
- Comprehensive rehabilitation management /
- Evidence summary /
- Evidence-based nursing

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表 1 纳入文献的一般特征

Table 1. General characteristics of included literature

纳入文献	证据类型	来源	文献主题	发表年份
STEIN R等^[10]	指南	ESPU	儿童与青少年神经源性膀胱保守治疗	2020
BLOK B等^[11]	指南	EAU	泌尿神经学指南	2022
中国康复委员会^[12]	指南	知网	神经源性膀胱护理实践指南	2017
JOSEPH D B等^[13]	指南	SBA	脊柱裂患者护理和管理的泌尿学指南	2020
GROEN J等^[14]	指南	EAU	神经源性膀胱尿路管理	2016
文建国等^[15]	指南	中华医学会	小儿神经源性膀胱诊断和治疗指南	2015
LEE B等^[16]	专家共识	BAPU	小儿脊柱裂膀胱功能障碍MDT合作治疗	2016
小儿盆底协会^[17]	专家共识	中华医学会	儿童清洁间歇导尿术中国专家共识	2022
TEKGUL S等^[18]	系统评价	Cochrane	EAU-ESPU指南对儿童日间下尿路疾病的建议	2020
TOH S L等^[19]	系统评价	Cochrane	益生菌在儿童神经源膀胱应用	2017
SAGER C等^[20]	系统评价	PubMed	小儿脊柱裂膀胱功能障碍的行为疗法	2022
YADAV P等^[21]	系统评价	PubMed	小儿下尿路功能障碍尿动力学	2022
LUCAS E等^[22]	系统评价	PubMed	小儿间歇导尿与定时排尿	2019
JOHNSTON A W等^[23]	系统评价	PubMed	小儿神经源膀胱与肠道管理	2020
SILVA T等^[24]	系统评价	pubmed	电刺激在小儿神经源性膀胱的应用	2022
PALLESCHI G等^[25]	系统评价	PubMed	神经源膀胱临床智能化算法管理	2018
注：ESPU为欧洲儿童泌尿外科协会(European Society for Paediatric Urology)；SBA为脊柱裂协会(Spina Bifida Association)；BAPU为英国儿童泌尿医师协会(British Association of Paediatric Urologists)。

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表 2 纳入指南各领域标准化百分比质量评价表(n=6)

Table 2. Standardized percentage quality assessment forms for each field included in the guidelines (n=6)

纳入指南	范围与目的	牵涉人员	开发严谨性	呈现清晰性	适用性	编撰独立性	≥60%领域数(个)	30%~60%领域数(个)	ICC值	推荐级别
ESPU^[10]	100.0	88.9	90.6	95.6	84.5	100.0	6	6	0.991	A
EAU^[11]	100.0	91.9	88.2	88.0	81.9	91.3	6	6	0.993	A
中国康复委员会^[12]	87.3	54.3	49.3	68.2	69.1	65.5	5	4	0.990	B
JOSEPH D B等^[13]	94.5	81.2	76.5	87.8	89.1	85.6	6	6	0.996	A
GROEN J等^[14]	97.2	78.4	86.2	86.5	94.4	85.4	6	6	0.994	A
文建国等^[15]	75.1	37.2	75.4	89.3	89.0	78.2	4	5	0.974	B

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表 3 小儿脊柱裂膀胱功能障碍全生命周期康复护理最佳证据

Table 3. Best evidence of comprehensive rehabilitation nursing for pediatric spina bladder dysfunction throughout the full continuum of care

类别	证据内容	证据分级	推荐级别
妊娠期及新生儿期：评估与早期筛查为重点	1.育龄期脊柱裂女性接受基因遗传咨询^{[16, 19]}	4	B
	2.新生儿出生后即开始间歇导尿并监测尿动力学^{[10, 16, 24-25]}	1	A
	3.出生1周完善体格检查及泌尿系统检查、膀胱功能及神经系统变化^[10-15]	2	A
	4.逼尿肌过度活动早期使用奥昔布宁^{[16, 19]}	2	A
	5.6~12周、6个月、9个月、1岁再次评估膀胱功能^{[10-11, 13]}，每年进行1次尿动力学检查，直到3岁^{[19, 22]}	2	A
学龄前期及学龄期：行为认知训练为重点	6.根据年龄、性别、经济条件及环境选择不同类型导尿管，推荐亲水导尿管^{[10, 15, 17]}	4	B
	7.无行为能力患儿需经培训后照护者操作^{[10, 15, 17]}	3	A
	8.CIC延迟患儿密切监测尿路感染情况，完善上尿路超声和尿动力学检查^{[10, 15, 17]}	1	A
	9.男童包茎和女童阴唇粘连需及时处理，导尿前行影像尿动力学检查排查表浅性膀胱肿瘤^[18]	2	B
	10.清洁导尿导管型号选择由个体决定^{[11, 18]}	3	B
	11.鼓励自行导尿^{[16, 19]}，尽可能采用无菌技术进行间歇性导尿^{[10, 18, 20]}	3	B
	12.益生菌可减少尿路感染^{[18, 24]}	4	B
	13.72小时排尿日记可无创评估下尿路症状^{[16, 19]}	3	B
	14.考虑心理压力对学龄期儿童行为的影响并尽早干预^{[16, 19]}	3	B
	15.难治性神经源膀胱推荐注射a型肉毒素，但注射部位存在争议^{[16, 19]}	4	B
	16.<3岁患儿每年3次及学龄期儿童每年2次尿常规及泌尿系统超声检查^{[19, 22]}	3	B
	17.据个体风险及临床病程，6年密切随访泌尿系统超声及尿动力学检查^{[19, 22]}	3	B
青春成长期：健康教育与随访为重点	18.青少年行CIC自我导尿定期培训，注意生活质量评估^{[19, 22]}	3	B
	19.对患者进行性发育咨询^{[16, 19]}	1	A
	20.生活质量与脊柱闭合不全的类型和水平无关^{[16, 19]}	2	A
	21.尽早启动肠道管理：饮食调整，口服泻药，定时排便^{[16, 19]}	3	B
	22.多学科团队合作是过渡性膀胱管理的关键^{[19, 22]}	1	A
	23.长期居家间歇导尿不推荐常规使用抗生素^{[19, 22]}	3	B
	24.合理稳定的膳食饮水量与正确的导尿时机和频次是做好CIC的核心要素^{[19, 22]}	3	B
	25.肝功能障碍及泌尿功能障碍需持续监测^{[19, 22]}	2	A
	26.蔓越莓汁、含有乳酸菌食物、维生素C胶囊可减少尿路感染^{[19, 22]}	5	B
	27.采用患者、照顾者和尿控专科医护人员共同合作模式^{[19, 22]}	3	B
	28.定期评估高危患者的上尿路，终身泌尿、神经、骨科多学科随访^{[19, 22]}	2	A
	29.仅治疗有症状尿路感染^{[19, 22]}	2	A
	30.评估具有自理能力患儿自制/失禁模式^{[19, 22]}	2	A
	31.针对性与生育问题，提供涵盖青春期和成长期的终身随访服务^{[19, 22]}	3	B
注：推荐级别A为强推荐，B为弱推荐。

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