脑卒中呼吸系统感染患者气道管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2023.01.004

摘要/Abstract

摘要：

目的检索、评价和整合脑卒中呼吸系统感染患者气道管理的最佳证据，为临床护理实践提供参考。方法使用计算机检索BMJ最佳临床实践、Best Practice、UpToDate、世界卫生组织官网、国际指南协作网、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、美国国立指南库、加拿大安大略注册护士协会网站、英国国家卫生与临床优化研究所指南网、苏格兰院际指南网、澳大利亚临床实践指南数据库、新西兰指南工作组、医脉通、Embase、the Cochrane Library、PubMed、中国知网、万方数据库、维普数据库、中国生物医学文献数据库等网站，检索关于脑卒中呼吸系统感染患者气道管理的最佳临床实践、指南、专家共识、证据总结、系统评价、Meta分析、随机对照试验。检索时限为2017年1月1日—2022年5月20日。由2名研究员对纳入的文献进行评价，并对符合质量标准的文献进行证据提取。结果共纳入20篇文献，包括2篇临床决策、8篇指南、4篇专家共识、3篇证据总结、1篇系统评价、2篇随机对照试验，从预防管理、气道吸引、气道湿化、管道护理、切口护理和撤机管理6个方面形成29条最佳证据。结论该研究总结了脑卒中呼吸系统感染患者气道管理的最佳证据，为医护人员提供循证依据，建议医护人员根据临床情景应用证据，完善气道管理的护理措施。

关键词: 脑卒中, 呼吸系统感染, 气道管理, 证据总结, 循证护理学

Abstract:

Objective To retrieve，evaluate and integrate the best evidence of airway nursing management in patients with respiratory infection after stroke，and to provide references for clinical nursing practice. Methods We systematically searched for the best evidence of airway nursing management in patients with respiratory infection after stroke in BMJ best practice，UpToDate，the World Health Organization website，Guidelines International Network，Joanna Briggs Institute，National Institute for Health and Clinical Excellence，Scottish Intercollegiate Guidelines Network，National Guideline Clearinghouse，Registered Nurses’ Association of Ontario，Australian Database of Clinical Practice Guidelines，New Zealand Guidelines Working Group，Yi Maitong Guidelines Network，Embase，the Cochrane Library，PubMed，CNKI，WanFang database，VIP database，SinoMed to collect the literature，including clinical guidelines，evidence summaries，best practice information sheets，expert consensuses，recommended practice，systematic reviews，Meta-analysis and randomized controlled trials. The retrieval period was nearly 5 years. There were 2 researchers evaluating the quality of the literature and extracting the data. Results 20 articles were selected，including 2 top clinical decisions，8 guidelines，3 evidence summaries，4 expert consensuses，1 systematic review，2 randomized controlled trials. 29 pieces of best evidence were formed from 6 aspects，including prevention and management，airway attraction，airway moist，pipeline care，incision nursing，ventilator management. Conclusion This study summarizes the best evidence of airway management in patients with respiratory infection after stroke，and provides evidence-based basis for medical staff. Medical staff should take good nursing measures for airway management according to clinical situation.

Key words: Stroke, Respiratory Tract Infections, Airway Management, Evidence Summary, Evidence-Based Nursing

郭桂华, 许小明, 王海靓, 刘宁. 脑卒中呼吸系统感染患者气道管理的最佳证据总结[J]. 中华护理杂志, 2023, 58(1): 31-38.

GUO Guihua, XU Xiaoming, WANG Hailiang, LIU Ning. Summary of the best evidence of airway nursing management in patients with respiratory infection after stroke[J]. Chinese Journal of Nursing, 2023, 58(1): 31-38.

图/表 5

图1 PubMed 检索策略

Figure 1 PubMed search strategies

图2 文献筛选流程图注:BMJ为最佳临床实践、NICE为英国国家卫生与临床优化研究所、GIN为国际指南协作网、RNAO为加拿大安大略注册护士协会、SIGN为苏格兰院际指南网、JBI为乔安娜布里格斯研究所。

Figure 2 Flow chart of literature screening

表1 纳入文献的一般特征（n=20）

Table 1 Characteristics of included studies（n=20）

表2 纳入指南的质量评价结果（n=11）

Table 2 Guidelines quality assessed by appraisal of guidelines for research and evaluation Ⅱ（n=11）

表3 脑卒中呼吸系统感染患者气道管理的最佳证据总结

Table 3 Evidence summary for airway nursing management of respiratory infections after stroke

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