成人重症患者诊断性失血预防及管理的最佳证据总结 [中文引用][英文引用]

目的  系统检索、评价及汇总成人重症患者诊断性失血预防及管理相关证据，为规范临床诊断性血液检验提供依据和参考。方法  采用 PIPOST 模式，即目标人群（population）、证据应用人员（professional）、结局（outcome）、证据应用场所（setting）和研究类型（type of evidence）构建结构化循证问题。根据“5S”证据金字塔模型，自上而下系统检索 BMJ Best Practice，UpToDate，澳大利亚 Joanna Briggs Institute（JBI）循证卫生保健中心数据库，国际指南协作网，苏格兰院际指南网，加拿大安大略省注册护士协会，英国国家卫生与临床优化研究所，医脉通指南网，世界卫生组织，澳大利亚国家血液管理局（National BloodAuthority，NBA），中华人民共和国国家卫生健康委员会，Cochrane Library，PubMed，Embase，CINAHL，Web of Science，万方医学网，中国知网，维普数据库，SinoMed 中关于成人重症患者诊断性失血预防及管理的相关证据，检索文献类型为临床决策、指南、证据总结、系统评价 /Meta 分析、随机对照试验、类实验研究、横断面研究、队列研究、专家共识 / 意见、行业标准，检索时限为2015年 1月 1日至 2025年 2月 10日。对纳入文献进行文献质量评价、证据提取和汇总、证据等级评定。结果  共纳入 19篇文献，其中指南 5 篇、系统评价 5 篇、随机对照试验 1 篇、类实验研究 2 篇、横断面研究 2 篇、行业标准 1 篇、专家共识 3 篇。从教育培训、采血评估、采血频率、减少采血量的策略、质量控制 5 个方面汇总了 26 条推荐意见。结论  该研究总结成人重症患者因诊断性血液检验所致失血预防及管理的最佳证据，为规范医护人员实施血液检查提供循证依据。

Objective To systematically retrieve，evaluate and summarise the best available evidence on prevention and management of diagnostic blood loss in critically ill adult patients and to provide guidance for standardising diagnostic blood sampling in clinical practice. Methods A structured evidence question was created using the PIPOST framework（Population，Intervention， Professional，Outcome，Setting and Type of evidence）. Guided by the“5S”levels-of-evidence pyramid，a top-down systematic search was conducted on databases of BMJ Best Practice，UpToDate，the Joanna Briggs Institute（JBI）EBP Database，GIN，SIGN，RNAO， NICE，Medlive Guideline，WHO，National Blood Authority（Australia），National Health Commission of China，Cochrane Library， PubMed，EMbase，CINAHL，Web of Science，Wanfang Data，CNKI，VIP，and SinoMed. Searched literature included clinical decision aids，guidelines，evidence summaries，systematic reviews Meta analysis，RCTs，quasi-experimental，cross-sectional，cohort studies and expert consensus/opinions. Search period covered between 1st January 2015 and 10th February 2025. Quality appraisal，evidence extraction，synthesis and grading were performed according to JBI and GRADE approaches. Results Nineteen articles were retrieved including five guidelines，five systematic reviews，one RCT，two quasi-experimental studies，two cross-sectional studies，one professional standard and three expert consensuses. A total of 26 recommendations were extracted and they were organised into five domains：education and training，blood-sampling assessment，frequency of sampling，strategies to minimise blood volume drawn，and quality control. Conclusion This evidence summary provides the best current guidance for preventing and managing iatrogenic blood loss caused by diagnostic testing in critically ill adults，providing evidence-based basis for standardizing blood tests by medical staff .