全球现有儿童腹泻临床实践指南的循证评价

中圖分类号 R452；R720.5 文献标志码 A 文章编号 1001-0408（2018）08-1109-08

DOI 10.6039/j.issn.1001-0408.2018.08.24

摘 要 目的：评价全球现有儿童腹泻临床实践指南，为临床实践和我国儿童腹泻循证指南的制定提供证据和方法学参考。方法：计算机系统检索PubMed、Embase、中国生物医学文献数据库、中国知网、维普、万方等数据库及指南相关网站，并补充检索纳入文献的参考文献，检索时限均为建库起至2017 年12月，采用指南研究与评价系统Ⅱ（AGREEⅡ）评价指南的方法学质量，由2名研究员独立完成，以组内相关系数（ICC）分析计算不同研究者评价结果的组间差异，并分析比较各指南的异同。结果：初检获得1 168篇相关文献，最终纳入指南15个，其中美国3个，英国2个，世界卫生组织（WHO） 2个，意大利、欧洲、印度、澳大利亚、马来西亚、新南威尔士、南非和中国各1个。15个指南中，10个为循证指南，5个为非循证指南，指南证据级别与推荐强度方法不一。两名研究员评价得分ICC >0.75，P<0.05，表明组间评价一致性高。15篇指南总体质量不高，纳入指南在AGREEⅡ各领域得分从高到低依次为：范围与目的 （84.44%）、表达的清晰性（79.82%）、参与人员（45.74%）、制定的严谨性（41.18%）、编辑的独立性（36.39%）、应用性 33.89%。指南推荐的主要防治方式大体一致：（1）预防和治疗脱水是儿童腹泻病治疗的关键环节；（2）各指南普遍认为补液期间继续母乳喂养可降低患儿脱水风险；（3）推荐锌制剂治疗腹泻以缩短病程；（4）合理使用抗菌药物等。结论：全球现有儿童腹泻指南整体质量有待提高。我国尚无综合全面的儿童腹泻循证指南，且我国目前儿童腹泻治疗现状和WHO标准存在一定差距，需建立规范化治疗方案。建议以AGREEⅡ条目为参考标准，同时结合国际指南报告规范标准，综合考虑我国儿童腹泻疾病负担及发病特征，制定符合我国国情的高质量儿童腹泻循证指南。

关键词 儿童腹泻；儿童急性胃肠炎；临床实践指南；指南研究与评价系统Ⅱ；循证评价

ABSTRACT OBJECTIVE： To evaluate the global existed diarrhea guidelines of children， and provide evidence and methodology reference for clinical practice and the formulation of diarrhea evidence-based guideline of children in China. METHODS： Retrieved from PubMed， Embase， CBM， CNKI， VIP， Wanfang databases and related websites， references included in studies were retrieved additionally from database building to Dec. 2017. The methodological quality of the guideline was evaluated by 2 researchers independently with guideline evaluation toolⅡ（AGREEⅡ）. ICC analysis was used to calculate the differences between the evaluation results of 2 researchers and analyze the difference of the guidelines. RESULTS： A total of 1 168 literatures were collected primarily， and 15 guidelines were involved finally， among which 3 guidelines were from USA， 2 from British， 2 from WHO， each one from Italy， Europe， India， Australia， Malaysia， New South Wales， South Africa and China， respectively. Of 15 guidelines， there were 10 evidence-based guidelines and 5 non-evidence-based guidelines； evidence levels of guidelines and the method of recommendation intensity were different. ICC of 2 researchers were higher than 0.75（P<0.05）， indicating good homogeneity among them. The quality of 15 guidelines were not high enough， and the scores of included guidelines in the field of AGREEⅡin descending order were as follows： scope and purpose（84.44%），clarity of presentation （79.82%），stakeholder involvement（45.74%），rigor of development （41.18%）， editorial independence （36.39%） and applicability （33.89%）. Main prevention and treatment method recommended by guideline included that （1） prevention and treatment of dehydration was the key link in the treatment of children’s diarrhea； （2） guidelines generally believed continuous breastfeeding during rehydration could reduce the risk of dehydration in children； （3） zinc preparation was recommended to shorten the course of diarrhea； （4） antibiotics were used rationally， etc. CONCLUSIONS： The quality of global existed diarrhea guidelines of children should be improved. There is no comprehensive diarrhea evidence- based guideline of children in China， and there is a large discrepancy between the situation of pediatric diarrhea therapy in China and WHO standard； it is urgent to establish a standard treatment. It is suggested to formulate high quality pediatric diarrhea guideline in accordance with the national conditions of China， based on standards for international guideline report， comprehensively considering disease burden and characteristics of pediatric diarrhea in China.

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