中华护理杂志 ›› 2023, Vol. 58 ›› Issue (13): 1640-1647.DOI: 10.3761/j.issn.0254-1769.2023.13.017
李丝静(), 江智霞(), 杨晓玲, 袁晓丽, 谢光辉, 罗娟, 董俊兰
收稿日期:
2022-12-17
出版日期:
2023-07-10
发布日期:
2023-06-29
通讯作者:
江智霞,E-mail:jzxhl@126.com作者简介:
李丝静:女,本科(硕士在读),E-mail:1017262698@qq.com
基金资助:
LI Sijing(), JIANG Zhixia(), YANG Xiaoling, YUAN Xiaoli, XIE Guanghui, LUO Juan, DONG Junlan
Received:
2022-12-17
Online:
2023-07-10
Published:
2023-06-29
摘要:
目的 探讨清醒俯卧位通气策略在急性低氧性呼吸衰竭(acute hypoxemic respiratory failure,AHRF)患者中的应用效果。 方法 计算机系统检索中国知网、万方数据库、维普数据库、PubMed、Embase、Web of Science、Cochrane Library中关于AHRF患者清醒俯卧位通气的随机对照试验和观察性研究,检索时限为建库至2022年8月,同时追溯纳入文献的参考文献。2名研究者独立按照纳入和排除标准进行文献筛选、资料提取以及质量评价,通过RevMan 5.3软件进行Meta分析。 结果 最终纳入12篇文献,包括5项随机对照试验和7项队列研究,共2 632例患者。Meta分析结果显示,清醒俯卧位通气组的插管率与常规护理组相比,差异具有统计学意义[RR=0.73,95%CI(0.65,0.82),P<0.001];病死率[RR=0.87,95%CI(0.74,1.03),P=0.110]、住院时间[MD=-1.05,95%CI(-4.22,2.12),P=0.520]与常规护理组相比,差异无统计学意义。7项研究报告了清醒俯卧位通气继发的不良反应,包括不适(8%~35%)、疼痛(7%~11%)、呕吐(2%~8%)、导管移位(4%~6%)、皮肤破溃(0.4%~4.0%)、低血压(4%)、静脉血栓栓塞(2.3%)、咳嗽(2%)、吸入性肺炎(1.5%)。患者单次俯卧位时间相差较大(1.25~15.00) h。 结论 清醒俯卧位通气可有效降低AHRF患者的插管率,尚不能减少患者的住院时间,并且对病死率的影响有待进一步验证。患者俯卧位时最常见的不良反应为不适和疼痛,其依从性受到影响。建议未来应开展高质量的研究,旨在强化清醒俯卧位通气护理管理,提高患者依从性,进一步提高治疗的成功率。
李丝静, 江智霞, 杨晓玲, 袁晓丽, 谢光辉, 罗娟, 董俊兰. 清醒俯卧位通气在急性低氧性呼吸衰竭患者中应用效果的Meta分析[J]. 中华护理杂志, 2023, 58(13): 1640-1647.
LI Sijing, JIANG Zhixia, YANG Xiaoling, YUAN Xiaoli, XIE Guanghui, LUO Juan, DONG Junlan. Effectiveness of awake prone positioning in patients with acute hypoxemic respiratory failure:a Meta-analysis[J]. Chinese Journal of Nursing, 2023, 58(13): 1640-1647.
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