目的·全面了解儿童造血干细胞移植后皮肤移植物抗宿主病（graft-versus-host disease，GVHD）评估与预防的临床现状，构建审查指标，并结合临床实际情况分析研究开展过程中的障碍因素与促进因素，制定变革策略。方法·以JBI循证卫生保健模式为理论指导框架，明确临床问题，构建循证实践团队，系统检索文献，评价和汇总证据，并结合证据构建审查指标及明确审查方法。采用渥太华研究应用模式，对证据的变革、潜在采纳者和实践环境3个维度进行障碍因素与促进因素分析，并制定相应的策略。结果·共纳入24条最佳证据，包含皮肤评估、皮肤防护、皮肤不良反应的处理、用药指导和随访与筛查5个维度。在此基础上构建22条审查指标。14条审查指标的执行率<60%，其中的10条审查指标的执行率为0；8条审查指标的执行率>60%，其中的6条审查指标执行率为100.00%。主要障碍因素为缺乏相关的培训、未形成合理的管理机制；主要促进因素有证据来源可靠、潜在相关者配合程度高。结合审查指标的执行率和障碍因素分析的结果，制定变革措施。结论·儿童造血干细胞移植后皮肤GVHD评估与预防的证据与临床实践存在较大差距；应基于障碍因素与促进因素，有效实施临床变革。

Objective ·To gain a comprehensive understanding of the current clinical status of assessment and prevention of cutaneous graft-versus-host disease (GVHD) after haematopoietic stem cell transplantation in children, construct review indicators, analyze obstacles and facilitators in the process of conducting the study in light of clinical reality, and formulate strategies for change. Methods ·Utilizing the JBI Evidence-Based Health Care Model as a theoretical guiding framework, the clinical problem was clarified. An evidence-based practice team was established, and a systematic literature search was conducted. The evidence was then evaluated and summarized. Additionally, review indicators were constructed, and review methods were clarified in relation to the evidence. Using the Ottawa Model of Research Use, the three dimensions of evidence change, potential adopters, and practice environment were analyzed for barriers and facilitators, and corresponding strategies were developed. Results ·A total of 24 pieces of best evidence were included in the study, comprising five dimensions: skin assessment, assessment of protection, management of adverse skin reactions, medication guidance and follow-up and screening. Twenty-two review indicators were constructed on this basis, of which 14 had an implementation rate of <60% and 10 had an implementation rate of 0%; 8 had an implementation rate of >60% and 6 had an implementation rate of 100.00%. The main obstacles were the lack of relevant training and the absence of a rational management mechanism. The main facilitating factors were reliable sources of evidence and a high level of cooperation from potential stakeholders. Considering the results of the analysis of the implementation rate of the indicators under review and the obstacles, alternative measures were formulated. Conclusion ·There is a large gap between the evidence and clinical practice for the assessment and prevention of cutaneous GVHD after paediatric haematopoietic stem cell transplantation. Clinical change should be effectively implemented based on barriers and facilitators.