快速康复外科理念在肺移植患者围手术期中应用的范围综述

doi:10.3761/j.issn.0254-1769.2022.16.015

摘要/Abstract

摘要： 目的对快速康复外科理念在肺移植患者围手术期中应用的研究进行范围审查，归纳和总结促进肺移植患者快速康复的方案，为临床实践及未来该领域的研究提供参考。方法采用Arksey和O’Malley制订的范围综述框架，系统检索PubMed、CINAHL、Cochrane Library、Web of Science、中国生物医学数据库、中国知网等数据库，并手工检索相关参考文献。检索时限为建库至2021年8月。研究类型包括随机对照试验、类实验研究、队列研究及观察性研究等。由2名研究人员依据文献纳入标准独立进行文献筛选和数据资料提取。结果最终纳入29篇文献，分析了以快速康复外科理念为核心的肺移植患者围手术期干预措施，主要涵盖供体肺管理、术前访视与评估、预防性应用抗生素和激素、麻醉管理、气道管理与肺保护性通气策略、多模式体温管理、多模式镇痛、早期拔除气管插管、呼吸功能锻炼、体能锻炼、强化健康教育、营养支持治疗、液体治疗、制订个性化免疫抑制方案、心理护理、远程居家管理及出院后随访等。结论肺移植患者快速康复研究尚处于起步阶段，尚缺乏快速康复标准化方案，后续需要高质量、大规模的随机对照试验以构建肺移植患者围手术期快速康复策略。

关键词: 肺移植, 快速康复外科, 范围综述, 围手术期护理

Key words: Lung Transplantation, Enhanced Recovery After Surgery, Scoping Review, Perioperative Nursing

郑晓敏, 蔡英华, 周海琴, 万霞. 快速康复外科理念在肺移植患者围手术期中应用的范围综述[J]. 中华护理杂志, 2022, 57(16): 2018-2024.

ZHENG Xiaomin, CAI Yinghua, ZHOU Haiqin, WAN Xia. The application of enhanced recovery after surgery in the perioperative period of lung transplantation:a scoping review[J]. Chinese Journal of Nursing, 2022, 57(16): 2018-2024.

图/表 1

参考文献 40

[1]	蔡英华, 姚勇. 肺移植临床护理实践[M]. 南京: 东南大学出版社, 2021:1-11.
	Cai YH,. Yao Y. Clinical nursing practice of lung transplantation[M]. Nanjing: Southeast University Press, 2021:1-11.
[2]	Chambers DC, Perch M, Zuckermann A, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation:thirty-eighth adult lung transplantation report-2021:focus on recipient characteristics[J]. J Heart Lung Transplant, 2021, 40(10):1060-1072.
[3]	Bos S, Vos R, van Raemdonck DE, et al. Survival in adult lung transplantation:where are we in 2020?[J]. Curr Opin Organ Transplant, 2020, 25(3):268-273.
[4]	McCartney SL, Patel C, del Rio JM. Long-term outcomes and management of the heart transplant recipient[J]. Best Pract Res Clin Anaesthesiol, 2017, 31(2):237-248.
[5]	Baganate F, Beal EW, Tumin D, et al. Early mortality after liver transplantation:defining the course and the cause[J]. Surge-ry, 2018, 164(4):694-704.
[6]	朱桂玲, 孙丽波, 王江滨, 等. 快速康复外科理念与围手术期护理[J]. 中华护理杂志, 2008, 43(3):264-265.
	Zhu GL, Sun LB, Wang JB, et al. Concept of enhanced recovery after surgery and perioperative care[J]. Chin J Nurs, 2008, 43(3):264-265.
[7]	Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surge-ry:a review[J]. JAMA Surg, 2017, 152(3):292-298.
[8]	Fessler J, Ouattara J, Feliot E, et al. Fast-tracking in lung transplantation[J]. J Heart Lung Transplant, 2020, 39(4):S101-S102.
[9]	王喜益, 叶志弘, 汤磊雯. 范围综述在护理领域的应用进展[J]. 中华护理杂志, 2019, 54(8):1259-1263.
	Wang XY, Ye ZH, Tang LW. An integrative review of scoping review applied in nursing literature[J]. Chin J Nurs, 2019, 54(8):1259-1263.
[10]	Arksey H, O’Malley L. Scoping studies:towards a methodological framework[J]. Int J Soc Res Methodol, 2005, 8(1):19-32.
[11]	Slama A, Schillab L, Barta M, et al. Standard donor lung pro-curement with normothermic ex-vivo lung perfusion:a pro-spective randomized clinical trial[J]. J Heart Lung Trans-plant, 2017, 36(7):744-753.
[12]	Loor G, Warnecke G, Villavicencio MA, et al. Portable normothermic ex-vivo lung perfusion,ventilation,and functional assessment with the Organ Care System on donor lung use for transplantation from extended-criteria donors (EXPAND):a single-arm,pivotal trial[J]. Lancet Respir Med, 2019, 7(11):975-984.
[13]	Whitford H, Kure CE, Henriksen A, et al. A donor PaO₂/FiO₂<300 mmHg does not determine graft function or survival after lung transplantation[J]. J Heart Lung Transplant, 2020, 39(1):53-61.
[14]	曹晓东, 黄云娟, 朱亭立, 等. 认知行为干预对行肺移植患者等待肺移植期间心理状态的影响[J]. 中华护理杂志, 2013, 48(5):455-458.
	Cao XD, Huang YJ, Zhu TL, et al. The effect of cognitive-behavioral therapy on psychological status of patients awaiting lung transplantation[J]. Chin J Nurs, 2013, 48(5):455-458.
[15]	Florian J, Rubin A, Mattiello R, et al. Impact of pulmonary re-habilitation on quality of life and functional capacity in patients on waiting lists for lung transplantation[J]. J Bras Pneu-mol, 2013, 39(3):349-356.
[16]	Pehlivan E, Mutluay F, Balcı A, et al. The effects of inspiratory muscle training on exercise capacity,dyspnea and respiratory functions in lung transplantation candidates:a randomized controlled trial[J]. Clin Rehabil, 2018, 32(10):1328-1339.
[17]	Pehlivan E, Balcı A, Kılıç L, et al. Preoperative pulmonary rehabilitation for lung transplant:effects on pulmonary function,exercise capacity,and quality of life;first results in Turkey[J]. Exp Clin Transplant, 2018, 16(4):455-460.
[18]	Gerity SL, Silva SG, Reynolds JM, et al. Multimedia education reduces anxiety in lung transplant patients[J]. Prog Transplant, 2018, 28(1):83-86.
[19]	丁思妍, 周海琴, 史晓芬, 等. 肺移植营养不良患者多学科营养管理方案的构建与应用[J]. 护理学杂志, 2021, 36(16):1-5.
	Ding SY, Zhou HQ, Shi XF, et al. Construction and application of multidisciplinary nutrition management scheme for malnourished patients undergoing lung transplantation[J]. J Nurs Sci, 2021, 36(16):1-5.
[20]	Verbeek GL, Myles PS, Westall GP, et al. Intra-operative protective mechanical ventilation in lung transplantation:a randomised,controlled trial[J]. Anaesthesia, 2017, 72(8):993-1004.
[21]	Dong L, Mizota T, Tanaka T, et al. Off-pump bilateral cadaveric lung transplantation is associated with profound intraoperative hypothermia[J]. J Cardiothorac Vasc Anesth, 2016, 30(4):924-929.
[22]	Giménez-Milà M, Videla S, Pallarés N, et al. Impact of surgical technique and analgesia on clinical outcomes after lung transplantation:a STROBE-compliant cohort study[J]. Medicine, 2020, 99(46):e22427.
[23]	Lewis TC, Sureau K, Katz A, et al. Enhanced recovery and opioid-sparing pain management following lung transplantation[J]. J Heart Lung Transplant, 2020, 39(4):S95.
[24]	Erkılınç A, Karaca Baysal P, Emre Gürcü M. Anesthetic management in lung transplantation:our single-center experience[J]. Turk Gogus Kalp Dama, 2021, 29(2):191-200.
[25]	Fessler J, Fischler M, Sage E, et al. Operating room extubation:a predictive factor for 1-year survival after double-lung transplantation[J]. J Heart Lung Transplant, 2021, 40(5):334-342.
[26]	Ghadimi K, Cappiello J, Cooter-Wright M, et al. Inhaled pulmonary vasodilator therapy in adult lung transplant:a randomized clinical trial[J]. JAMA Surg, 2022, 157(1):e215856.
[27]	Tague LK, Bedair B, Witt C, et al. Lung protective ventilation based on donor size is associated with a lower risk of severe primary graft dysfunction after lung transplantation[J]. J Heart Lung Transplant, 2021, 40(10):1212-1222.
[28]	钟劲, 于翠香, 陶红梅, 等. 液体管理策略在肺移植术后患者中的应用[J]. 中华护理杂志, 2019, 54(5):678-681.
	Zhong J, Yu CX, Tao HM, et al. Application of fluid management strategy in patients received lung transplantation[J]. Chin J Nurs, 2019, 54(5):678-681.
[29]	Entwistle TR, Green AC, Fildes JE, et al. Adherence to medite-rranean and low-fat diets among heart and lung transplant recipients:a randomized feasibility study[J]. Nutr J, 2018, 17(1):22-29.
[30]	潘红, 蔡英华, 许正红, 等. 营养支持联合早期运动对肺移植术后患者康复的影响[J]. 护理学杂志, 2019, 34(9):42-44.
	Pan H, Cai YH, Xu ZH, et al. Effect of nutrition support combining with early exercise on lung rehabilitation in patients undergoing lung transplantation[J]. J Nurs Sci, 2019, 34(9):42-44.
[31]	Song YP, Cui XL, Zhang Y, et al. Home-based computerized cognitive training for postoperative cognitive dysfunction after lung transplantation in elderly population:a randomized controlled trial[J]. J Nerv Ment Dis, 2019, 207(8):693-699.
[32]	Shiner CT, Woodbridge G, Skalicky DA, et al. Multidisciplinary inpatient rehabilitation following heart and/or lung transplantation-examining cohort characteristics and clinical outcomes[J]. PM R, 2019, 11(8):849-857.
[33]	Guldager TB, Hyldgaard C, Hilberg O, et al. An e-learning program improves patients’ knowledge after lung transplantation[J]. Telemed J E Health, 2021, 27(7):800-806.
[34]	DeVito Dabbs A, Song MK, Myers BA, et al. A randomized controlled trial of a mobile health intervention to promote self-management after lung transplantation[J]. Am J Transplant, 2016, 16(7):2172-2180.
[35]	Schenkel FA, Barr ML, McCloskey CC, et al. Use of a Bluetooth tablet-based technology to improve outcomes in lung transplantation:a pilot study[J]. Am J Transplant, 2020, 20(12):3649-3657.
[36]	周海琴, 裴友, 张沁枫, 等. 肺移植患者居家监测管理App的设计与应用[J]. 护理学杂志, 2019, 34(2):18-20,43.
	Zhou HQ, Pei Y, Zhang QF, et al. Development and application of a mobile App for home monitoring of lung transplant patients[J]. J Nurs Sci, 2019, 34(2):18-20,43.
[37]	Ulvestad M, Godang K, Durheim MT, et al. Effect of high-intensity training on bone health and body composition in lung transplant recipients:a secondary analysis of a randomized controlled trial[J]. Clin Transplant, 2021, 35(8):e14375.
[38]	Fuller LM, Button B, Tarrant B, et al. Longer versus shorter duration of supervised rehabilitation after lung transplantation:a randomized trial[J]. Arch Phys Med Rehabil, 2017, 98(2):220-226.
[39]	Ochman M, Maruszewski M, Latos M, et al. Nordic walking in pulmonary rehabilitation of patients referred for lung transplantation[J]. Transplant Proc, 2018, 50(7):2059-2063.
[40]	胡春晓, 李小杉, 卫栋, 等. 前进中的肺移植事业—我国肺移植发展现状及未来[J]. 器官移植, 2020, 11(02):204-207.
	Hu CX, Li XS, Wei D, et al. The development of lung transplantation:current situation and future of lung transplantation in China[J]. Organ Transplant, 2020, 11(02):204-207.