基于临床实践指南的糖尿病足预防、评估、诊断及管理：一项系统综述
Prevention, assessment, diagnosis and management of diabetic foot based on clinical practice guidelines: A systematic review.
作者信息
Pérez-Panero Alberto J, Ruiz-Muñoz María, Cuesta-Vargas Antonio I, Gónzalez-Sánchez Manuel
机构信息
Department of Nursing and Podiatry.
Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos 29071, Málaga, Spain.
出版信息
Medicine (Baltimore). 2019 Aug;98(35):e16877. doi: 10.1097/MD.0000000000016877.
AIM
Diabetic foot complications are the main reason for hospitalization and amputation in people with diabetes and have a prevalence of up to 25%. Clinical practice guidelines are recommendations based on evidence with the aim of improving health care. The main aim of this study was to carry out a systematic review of the levels of the evaluation and treatment strategies that appear in the clinical practice guidelines focus on diabetic foot or diabetes with diabetic foot section. Another objective of this study was to perform an analysis of the levels of evidence in support of the recommendations made by the selected clinical practice guidelines.
METHODS
A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and a quality assessment by the Appraisal of Guidelines for Research and Evaluation (AGREE II) were performed. The databases checked were "NICE", "Cinahl", "Health Guide", "RNAO", "Sign", "PubMed", "Scopus" and "NCG". The search terms included were "diabetic foot", "guideline(s)", "practice guideline(s)" and "diabetes."
RESULTS
Twelve articles were selected after checked inclusion criteria and quality assessment. A summary and classification of the recommendations was completed.
CONCLUSIONS
The heterogeneity of levels of evidence and grades of recommendation of the CPGs included regarding the management, approach and treatment of DF makes it difficult to interpret and assume them in clinical practice in order to select the most correct procedures. Despite this and according to the detailed study of the guidelines included in this work, it can be concluded that the highly recommendable interventions for DF management are debridement (very high level of evidence and strongly recommended), foot evaluation (moderate level of evidence and fairly recommended) and therapeutic footwear (moderate level of evidence and fairly recommended).
目的
糖尿病足并发症是糖尿病患者住院和截肢的主要原因，患病率高达25%。临床实践指南是基于证据的建议，旨在改善医疗保健。本研究的主要目的是对临床实践指南中关于糖尿病足或糖尿病合并糖尿病足章节的评估水平和治疗策略进行系统评价。本研究的另一个目的是对所选临床实践指南所提建议的证据水平进行分析。
方法
根据系统评价和Meta分析的首选报告项目（PRISMA）进行系统评价，并采用研究与评价指南评估（AGREE II）进行质量评估。检索的数据库有“英国国家卫生与临床优化研究所（NICE）”、“护理学与健康领域数据库（Cinahl）”、“健康指南”、“安大略注册护士协会临床实践指南（RNAO）”、“苏格兰校际指南网络（Sign）”、“医学期刊数据库（PubMed）”、“斯高帕斯数据库（Scopus）”和“国家指南库（NCG）”。检索词包括“糖尿病足”、“指南”、“临床实践指南”和“糖尿病”。
结果
在检查纳入标准和质量评估后，选择了12篇文章。完成了建议的总结和分类。
结论
所纳入的临床实践指南在糖尿病足的管理、处理和治疗方面的证据水平和推荐等级存在异质性，这使得在临床实践中难以解释和采用这些指南来选择最正确的程序。尽管如此，根据本研究中所纳入指南的详细研究，可以得出结论，糖尿病足管理中高度推荐的干预措施是清创术（证据水平非常高且强烈推荐）、足部评估（证据水平中等且相当推荐）和治疗性鞋具（证据水平中等且相当推荐）。
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