慢性呼吸道疾病患者非药物气道廓清技术的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.10.016

摘要/Abstract

摘要：

目的总结慢性呼吸道疾病患者非药物气道廓清技术的最佳证据。方法计算机检索国内外数据库、指南网、临床决策支持系统及呼吸专业相关协会网站等，检索文献类型包括指南、专家共识、临床决策、推荐实践、系统评价等，检索时限为建库至2022年5月。由2名研究者评价文献质量和汇总证据。结果共纳入16篇文献，包括6篇指南、6篇专家共识、1篇推荐实践、3篇系统评价。从治疗前评估、干预措施、注意事项、频率与时间、疗效评估及健康教育6个方面，汇总了20条非药物气道廓清技术的证据，同时汇总了包括有效咳嗽或用力呼气、手法辅助咳嗽、主动循环呼吸技术、自体引流、手法治疗、体位引流、高频胸壁振荡、呼气正压或振荡呼气正压8项非药物气道廓清技术的32条使用原则。结论医护人员在临床应用非药物气道廓清技术时，应根据患者的个体情况，审慎地制订气道廓清方案，以促进患者获益最大化。

关键词: 呼吸道疾病, 气道廓清, 非药物干预, 循证护理学, 证据总结

Abstract:

Objective To summarize the best evidence for non-pharmacological airway clearance techniques in patients with chronic respiratory diseases. Methods We searched domestic and international databases，guideline networks，clinical decision support systems and websites of respiratory professional associations. The types of the literature include guidelines，expert-consensuses，clinical decision-making，recommended practices and systematic re-views. The retrieval time is from the establishment of the databases to May 2022. There were 2 investigators who evaluated the quality of the literature and pooled evidence. Results A total of 16 publications were included，in-volving 6 guidelines，6 expert consensus articles，1 recommended practice，and 3 systematic reviews. A summary of the best evidence for the overall requirements of 20 airway clearance techniques in 6 areas，namely pre-treatment assessment，interventions，precautions，frequency and duration，assessment of efficacy and health education. 8 com-monly used airway clearance techniques were also summarized，with 32 pieces of evidence for the principles of use，including effective cough or huffing，maneuver-assisted cough，active cycle of breathing techniques，autogenous drainage，manual techniques，postural drainage，high-frequency chest wall oscillatory，and positive expiratory pressure or oscillating positive expiratory pressure. Conclusion In the clinical application of non-pharmacological airway clearance techniques，medical staff should carefully formulate airway clearance techniques plan according to the individual situation of patients，so as to maximize the benefits of patients.

Key words: Respiratory Tract Diseases, Airway Clearance, Non-Pharmacotherapy, Evidence-Based Nursing, Evidence Summary

郑江, 汉瑞娟, 王岩, 张红霞, 柴梅梅, 祁万君, 李玉兰. 慢性呼吸道疾病患者非药物气道廓清技术的最佳证据总结[J]. 中华护理杂志, 2023, 58(10): 1253-1260.

ZHENG Jiang, HAN Ruijuan, WANG Yan, ZHANG Hongxia, CHAI Meimei, QI Wanjun, LI Yulan. Summary of the best evidence for non-pharmacological airway clearance techniques in patients with chronic respiratory diseases[J]. Chinese Journal of Nursing, 2023, 58(10): 1253-1260.

图/表 4

表1 纳入文献的基本信息（n=16）

Table 1 Characteristics of include studies（n=16）

表2 纳入指南质量评价结果（n=6）

Table 2 Quality evaluation of guidelines（n=6）

表3 非药物气道廓清技术总体要求的最佳证据总结

Table 3 Summary of evidence for overall requirements for non-pharmacological airway clearance techniques

表4 8项非药物气道廓清技术使用原则的最佳证据总结

Table 4 Summary of evidence on the use principles of commonly used non-pharmacological airway clearance

参考文献 35

[1]	Labaki WW, Han MK. Chronic respiratory diseases:a global view[J]. Lancet Respir Med, 2020, 8(6):531-533. DOI URL
[2]	宫玉翠, 陈洁雅, 李平东, 等. 慢性呼吸疾病肺康复护理专家共识[J]. 中华护理杂志, 2020, 55(5):709-710. DOI URL
	Gong YC, Chen JY, Li PD, et al. Expert consensus on pul-monary rehabilitation nursing of chronic respiratory diseases[J]. Chin J Nurs, 2020, 55(5):709-710.
[3]	申永春, 文富强. 《慢性气道炎症性疾病气道黏液高分泌管理中国专家共识》解读[J]. 中国实用内科杂志, 2016, 36(2):131-132,136. DOI
	Shen YC, Wen FQ. Interpretation of expert consensus on clini-cal management of airway mucus hypersecretion in chronic airway inflammatory diseases in the People’s Republic of China[J]. Chin J Pract Intern Med, 2016, 36(2):131-132,136.
[4]	汪璐璐, 徐凤玲, 刘钢, 等. 机械通气患者早期肺康复分级方案的构建与应用研究[J]. 中华护理杂志, 2020, 55(8):1125-1132. DOI URL
	Wang LL, Xu FL, Liu G, et al. Construction and preliminary application of early pulmonary rehabilitation grading scheme for patients with mechanical ventilation[J]. Chin J Nurs, 2020, 55(8):1125-1132. DOI URL
[5]	Belli S, Prince I, Savio G, et al. Airway clearance techniques:the right choice for the right patient[J]. Front Med (Lausan-ne), 2021, 8:544826.
[6]	Coppolo DP, Schloss J, Suggett JA, et al. Non-pharmaceutical te-chniques for obstructive airway clearance focusing on the role of oscillating positive expiratory pressure(OPEP):a narrative review[J]. Pulm Ther, 2022, 8(1):1-41. DOI
[7]	杨梅, 钟就娣, 张俊娥, 等. 老年肺癌手术患者主动循环呼吸技术训练自信心培养的效果评价[J]. 中华护理杂志, 2018, 53(5):523-527.
	Yang M, Zhong JD, Zhang JE, et al. The effects of enhancing confidence of active cycle of breathing technique training on pulmonary rehabilitation in elder lung cancer patients with lung resection[J]. Chin J Nurs, 2018, 53(5):523-527.
[8]	Goetz RL, Vijaykumar K, Solomon GM. Mucus clearance strate-gies in mechanically ventilated patients[J]. Front Physiol, 2022, 13:834716. DOI URL
[9]	宋琼, 沈美芳, 饶晓玲. 呼吸内科护理人员非药物性气道廓清技术的认知调查[J]. 护理学杂志, 2020, 35(16):49-51.
	Song Q, Shen MF, Rao XL. Investigation on knowledge level of non-medicated airway clearance technique among nurses working in the department of respiratory diseases[J]. J Nurs Sci, 2020, 35(16):49-51.
[10]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[11]	Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009, 12(4):99-101. DOI PMID
[12]	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ:advan-cing guideline development,reporting,and evaluation in health care[J]. Prev Med, 2010, 51(5):421-424. DOI PMID
[13]	McArthur A, Klugárová J, Yan H, et al. Innovations in the sys-tematic review of text and opinion[J]. Int J Evid Based Healthc, 2015, 13(3):188-195. DOI URL
[14]	熊俊, 陈日新. 系统评价/Meta分析方法学质量的评价工具AMSTAR[J]. 中国循证医学杂志, 2011, 11(9):1084-1089.
	Xiong J, Chen RX. An introduction to a measurement tool to assess the methodological quality of systematic reviews/Meta-analysis:AMSTAR[J]. Chin J Evid Based Med, 2011, 11(9):1084-1089.
[15]	Higgins J, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions[M]. 2nd ed. Hoboken, NJ:Wiley-Blackwell, 2019.
[16]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[17]	Tang CY, Taylor NF, Blackstock FC. Chest physiotherapy for patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease(COPD):a systematic review[J]. Physiotherapy, 2010, 96(1):1-13. DOI URL
[18]	Osadnik CR, McDonald CF, Jones AP, et al. Airway clearance techniques for chronic obstructive pulmonary disease[J]. Coch-rane Database Syst Rev, 2012(3):CD008328.
[19]	成人支气管扩张症诊治专家共识编写组. 成人支气管扩张症诊治专家共识[J]. 中华结核和呼吸杂志, 2012, 35(7):485-492.
	Expert Consensus Writing Group for Diagnosis and Treatment of Adult Bronchiectasis. Expert consensus on diagnosis and treatment of adult bronchiectasis[J]. Chin J Tuberc Respir Dis, 2012, 35(7):485-492.
[20]	Strickland SL, Rubin BK, Drescher GS, et al. AARC clinical practice guideline:effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients[J]. Respir Care, 2013, 58(12):2187-2193. DOI PMID
[21]	Lee AL, Burge AT, Holland AE. Airway clearance techniques for bronchiectasis[J]. Cochrane Database Syst Rev, 2015, 2015(11):CD008351.
[22]	慢性气道炎症性疾病气道黏液高分泌管理中国专家共识编写组. 慢性气道炎症性疾病气道黏液高分泌管理中国专家共识[J]. 中华结核和呼吸杂志, 2015, 38(10):723-729.
	Compiling Group of Chinese Expert Consensus on the Management of Airway Mucus Hypersecretion in Chronic Airway Inflammatory Diseases. Chinese expert consensus on the management of airway mucus hypersecretion in chronic airway inflammatory diseases[J]. Chin J Tuberc Respir Dis, 2015, 38(10):723-729.
[23]	Polverino E, Goeminne PC, McDonnell MJ, et al. European Res-piratory Society guidelines for the management of adult bronchiectasis[J]. Eur Respir J, 2017, 50(3):1700629.
[24]	Al-Jahdali H, Alshimemeri A, Mobeireek A, et al. The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis[J]. Ann Thorac Med, 2017, 12(3):135-161. DOI PMID
[25]	中华医学会呼吸病学分会哮喘学组. 上-下气道慢性炎症性疾病联合诊疗与管理专家共识[J]. 中华医学杂志, 2017, 97(26):2001-2022.
	Asthma Group, Respiratory Branch, Chinese Medical Association. Expert consensus on joint diagnosis,treatment and management of chronic inflammatory diseases of upper and lower airway[J]. Natl Med J Chin, 2017, 97(26):2001-2022.
[26]	Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic So-ciety guideline for bronchiectasis in adults[J]. BMJ Open Res-pir Res, 2018, 5(1):e000348.
[27]	葛慧青, 孙兵, 王波, 等. 重症患者气道廓清技术专家共识[J]. 中华重症医学电子杂志(网络版), 2020, 6(3):272-282.
	Ge HQ, Sun B, Wang B, et al. Expert consensus of airway clearance in critically ill patients[J]. Chin J Crit Care Intensive Care Med(Electron Ed), 2020, 6(3):272-282.
[28]	Hadda V, Suri TM, Pahuja S, et al. Secretion management in patients with ineffective airway clearance with non-invasive mechanical ventilation use:expert guidance for clinical practice[J]. Arch Monaldi Le Malattie Del Torace, 2021, 91(4):14-21.
[29]	中国医师协会呼吸医师分会, 中华医学会呼吸病学分会, 中国康复医学会呼吸康复专业委员会, 等. 中国慢性呼吸道疾病呼吸康复管理指南(2021年)[J]. 中华健康管理学杂志, 2021, 15(6):521-538.
	Chinese Association of Chest Physicians,Chinese Thoracic Society, Respiratory Rehabilitation Committee of Chinese Association of Rehabilitation Medicine, et al. Guidelines for res-piratory rehabilitation management of chronic respiratory dis-eases in China[J]. Chin J Health Manag, 2021, 15(6):521-538.
[30]	支气管扩张症专家共识撰写协作组, 中华医学会呼吸病学分会感染学组. 中国成人支气管扩张症诊断与治疗专家共识[J]. 中华结核和呼吸杂志, 2021, 44(4):311-321.
	Bronchiectasis Expert Consensus Writing Collaboration Group, Infection Group,Respiratory Branch,Chinese Medical Association. Expert consensus on the diagnosis and treatment of adult bronchiectasis in China[J]. Chin J Tuberc Respir Dis, 2021, 44(4):311-321.
[31]	魏莉莉, 刘海. 慢性阻塞性肺疾病临床康复循证实践指南[J]. 中国康复理论与实践, 2021, 27(1):15-26. DOI
	Wei LL, Liu H. Evidence-based practice guidelines for clinical rehabilitation of chronic obstructive pulmonary disease[J]. Chin J Rehabil Theory Pract, 2021, 27(1):15-26.
[32]	中国医学装备协会呼吸病学装备专业委员会, 中国残疾人康复协会肺康复专业委员会中青年肺康复专业学组. 针对气道黏液高分泌的呼吸康复治疗中国专家共识[J]. 国际呼吸杂志, 2021, 41(22):1686-1696.
	Respiratory Equipment Committee of China Association of Medical Equipment,Young and Middle-aged Pulmonary Rehabilitation Committee of Pulmonary Rehabilitation Committee of China Association of Rehabilitation of Disabled Person. China experts’ consensus on respiratory rehabilitation therapy for airway mucus hypersecretion[J]. Int J Respir, 2021, 41(22):1686-1696.
[33]	Abdel HA, AboEl HH, Fathy KA. Comparison between active cycles of breathing with postural drainage versus conventional chest physiotherapy in subjects with bron-chiectasis[J]. Egypt J Chest Dis Tuberc, 2016, 65(1):157-165. DOI URL
[34]	张金峰, 王爱民, 许丽辉, 等. 背部腧穴叩击配合弹拨法对机械通气患者排痰效果的研究[J]. 中华护理杂志, 2016, 51(8):939-942.
	Zhang JF, Wang AM, Xu LH, et al. The effects of chest percussion and vibration at Bei Shu Points on sputum expectoration among patients undergoing mechanical ventilation[J]. Chin J Nurs, 2016, 51(8):939-942.
[35]	Daynes E, Jones AW, Greening NJ, et al. The use of airway clea-rance devices in the management of chronic obstructive pulmonary disease. A systematic review and Meta-analysis of randomized controlled trials[J]. Ann Am Thorac Soc, 2021, 18(2):308-320. DOI URL