成人危重症患者气道管理的最佳证据总结

doi:10.16460/j.issn1008-9969.2021.03.039

摘要/Abstract

摘要： 目的遴选并获取国内外成人危重症患者气道管理的相关证据,为临床实践管理提供依据。方法按照PIPOST模式确定循证问题,使用计算机检索Up To Date、Cochrane Library、BMJ、NGC、PubMed、SCCM、NICE、JBI、CINAHL、Medline、CNKI、CBM和万方数据库,选出符合纳入标准的文献,由2名循证研究员独立对纳入的文献进行质量评价,结合专业人士的判断提取及综合证据。结果共纳入25篇文献,其中高级临床决策支持1篇、指南7篇、系统评价8篇、证据总结5篇、专家共识4篇。最佳证据分别从气道评估、气道吸引时机、气囊管理、气道湿化、气道吸引、气管切开造口护理、口腔护理7个方面进行总结,共44条最佳证据。结论临床实践中医务人员需加强气道管理循证知识的培训,动态评估患者气道情况,把握气道吸引时机,重视气囊管理和气道湿化,明确气道吸引注意事项,规范气管切开造口护理流程,加强患者口腔护理,根据临床实际情况,有针对性的选择证据。

关键词: 危重症患者, 人工气道, 管理, 证据总结

Abstract: Objective To select and obtain relevant evidence on airway management of critically-ill adults at home and abroad, and to provide reference for clinical management. Methods Evidence-based issues in accordance with the PIPOST model were identified and we searched UpToDate, Cochrane library, BMJ, NGC, PubMed, SCCM, NICE, JBI, CINAHL, Medline, CNKI, CBM Database and Wanfang Database for eligible literature. Two evidence-based researchers independently evaluated the quality of the included literature, extracted and synthesized evidence. Results There were 25 articles including 1 advanced clinical decision support, 7 guidelines, 8 systematic evaluations, 5 evidence summaries and 4 expert consensus. A total of 44 pieces of best evidence was summarized from 7 aspects of airway evaluation, airway attraction timing, cuff pressure management, airway humidification, airway suctioning, tracheostomy stoma care, and oral nursing. Conclusion In clinical practice, medical staff should strengthen the training of evidence-based knowledge of airway management. Dynamical assessment of airway conditions, the timing of airway suction, cuff pressure management and airway humidification, precautions for airway suction, and standardized tracheostomy care process, and oral care of patients are conducive to the recovery of patients.

Key words: critically ill patient, artificial airway, management, evidence summary

中图分类号:

R473

严玉娇, 丁娟, 刘晁含, 付沫, 王虹. 成人危重症患者气道管理的最佳证据总结[J]. 护理学报, 2021, 28(3): 39-45.

YAN Yu-jiao, DING Juan, LIU Chao-han, FU Mo, WANG Hong. Best Evidence Summary for Airway Management in Critically-ill Adult Patients[J]. Journal of Nursing, 2021, 28(3): 39-45.

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