【摘要】 目的 基于证据图谱方法 系统梳理、分析与评价神经源性膀胱(neurogenic bladder,NB)护理相关临床实践指南(clinical practice guidelines,CPGs),为临床护理循证决策提供支持,明确研究趋势并推动高质量可信CPGs的制订。方法 系统检索PubMed、Web of Science、Embase、CBM、中国知网、万方数据库、维普数据库及国际NB相关学术组织发布的CPCGs,检索时限为建库至2024年3月31日,纳入含NB护理内容的中英文完整版CPGs。采用指南研究与评价工具Ⅱ(the Appraisal of Guidelines for Research&EvaluationⅡ,AGREEⅡ)评估CPGs方法 学质量,指南研究与评估系统最佳推荐意见的质量评价工具(Appraisal of Guidelines REsearch and Evaluation-Recommendations Excellence,AGREE-REX)评价推荐意见有效性,对比分析推荐意见特异性、证据分级体系及实施一致性。由2名研究者独立筛选、提取并交叉核对数据,5名研究者协作完成数据分析与质量评价,分歧通过讨论或第三方协商解决。结果 纳入11个国家/地区19种CPGs,78.95%(15/19)采用证据分级体系,68.42%(13/19)明确推荐强度。AGREEⅡ领域评分差异显著(30.00%～86.70%),“制订严谨性”(41.70%)、“编辑独立性”(43.30%)和“应用性”(30.00%)未达合格标准。AGREE-REX评分显示“临床适用性”(55.56%)和“可实施性”(41.67%)相对突出。系统整合40项推荐意见,90%(36/40)达成共识,10%(4/40)存在矛盾,涵盖6大主题:1)护理评估;2)辅助排尿;3)行为治疗;4)间歇导尿;5)留置导尿;6)其他疗法。结论 NB护理相关CPGs的方法 学质量与推荐意见存在显著异质性,亟待提升CPGs整体质量。需加强深度研究并及时更新CPGs,缩小其与临床实践的差距。更多还原

【Abstract】 Objectives: This study employed evidence mapping to systematically evaluate clinical practice guidelines(CPGs) for neurogenic bladder(NB) care. We aimed to identify research trends, evidence gaps, and consensus patterns to inform evidence-based nursing practices and support the formulation of highquality CPGs.Methods: A systematic search of electronic databases and guideline repositories was conducted,included Pub Med, Web of Science, Embase, Guidelines International Network(GIN), ect. Eligible NB guidelines underwent dual-researcher screening and extraction, and methodological and recommendation quality were assessed using the Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ)and Evaluation-Recommendations Excellence(AGREE-REX) instruments. Five researchers independently evaluated recommendation specificity, evidence grading systems, and implementation consistency. Discrepancies were resolved through consensus discussion or third-party arbitration.Results: Analysis of 19 CPGs(2006–2023) from 11 countries/regions revealed that 78.95 %(15/19)incorporated evidence grading systems and 68.42 %(13/19) specified recommendation strength. The AGREE Ⅱ evaluation identified critical methodological deficiencies, with three domains scoring below the acceptable thresholds: Rigor of Development(41.70 %), Editorial Independence(43.30 %), and Applicability(30.00 %). The AGREE-REX results showed moderate performance in Clinical Applicability(55.56 %) and implantability(41.67 %) but severe gaps in Values and Preferences(25.00 %). A systematic synthesis identified 40 recommendations: 90 %(36/40) demonstrated consensus and 10 %(4/40) contradictions. These studies addressed the following six clinical themes: 1) nursing assessment, 2)manipulation-assisted voiding, 3) behavioral therapy, 4) intermittent catheterization, 5) indwelling catheterization, and 6) other therapies.Conclusions: The methodologies and recommendations of the CPGs for NB in nursing demonstrated substantial variability. Therefore, there is an urgent need to improve the quality of the NB-related CPGs.More in-depth research and timely updates are required to enhance the practical utility of CPGs and narrow the gap between CPGs and clinical practice.更多还原