成人急性呼吸窘迫综合征患者俯卧位通气管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2022.15.013

摘要/Abstract

摘要：

目的总结成人急性呼吸窘迫综合征患者俯卧位通气管理的最佳证据,为俯卧位通气护理实践提供参考。方法基于PIPOST工具确定循证问题,检索国内外数据库及相关网站中关于成人急性呼吸窘迫综合征患者俯卧位通气管理的临床决策、指南、证据总结、系统评价、推荐实践及专家共识,检索时限为建库至2022年2月10日,并对符合纳入标准的文献进行质量评价及证据提取。结果共纳入13篇文献,其中临床决策1篇、指南7篇、专家共识2篇及系统评价3篇。从操作前评估、操作的实施、结束俯卧位通气的时机、并发症的预防及人员组织管理5个方面进行证据汇总,形成34条最佳证据。结论该研究汇总的最佳证据可为临床医护人员实施俯卧位通气提供参考,但在临床实践中还需结合具体情况,有针对性地选择、应用证据,从而提高俯卧位通气的安全性及治疗效果。

关键词: 呼吸窘迫综合征,成人, 俯卧位, 机械通气, 证据总结, 循证护理学

Abstract:

Objective To summarize the best evidence for the management of prone ventilation in adult patients with acute respiratory distress syndrome,so as to provide references for the nursing practice of prone position ventilation. Methods Based on the PIPOST tool to establish evidence-based issues,relevant domestic and foreign databases and websites were searched for clinical decisions,guidelines,evidence summaries,systematic reviews,recommended practices,and expert consensuses on the management of prone ventilation in adults with acute respiratory distress syndrome. The retrieval time was from the establishment of the database to February 10,2022,and the quality evaluation and evidence extraction of the literature that met the inclusion criteria were carried out. Results A total of 13 articles were included,including 1 clinical decision,7 guidelines,2 expert consensuses and 3 systematic evaluations. 34 pieces of best evidence were summarized from 5 dimensions,namely pre-operation evaluation,operation implementation,end of prone ventilation,complication prevention and personnel organization management. Conclusion The best evidence summarized in this study can provide a reference for clinical medical staff to implement prone position ventilation,but in clinical practice,it is necessary to select and apply evidence in a targeted manner in combination with specific circumstances,so as to improve the safety and therapeutic effect of prone position ventilation.

Key words: Respiratory Distress Syndrome,Adult, Prone Position, Mechanical Ventilation, Evidence Summary, Evidence-Based Nursing

蒋燕, 陆叶, 蒋旭琴, 王娟, 崔静萍. 成人急性呼吸窘迫综合征患者俯卧位通气管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(15): 1878-1885.

JIANG Yan, LU Ye, JIANG Xuqin, WANG Juan, CUI Jingping. Best evidence summary for prone ventilation management in adults with acute respiratory distress syndrome[J]. Chinese Journal of Nursing, 2022, 57(15): 1878-1885.

图/表 4

图1 文献筛选流程图

Figure 1 Flow chart of literature screening

表1 纳入文献的一般特征（n=13）

Table 1 General characteristics of the included literature（n=13）

表2 纳入指南的质量评价结果（n=7）

Table 2 Quality evaluation of the included in the guidelines（n=7）

表3 成人急性呼吸窘迫综合征患者俯卧位通气管理最佳证据总结

Table 3 Best evidence for prone ventilation management in adults with acute respiratory distress syndrome

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