体外膜肺氧合清醒患者早期活动的最佳证据总结

doi:10.3761/j.issn.0254-1769.2024.03.014

摘要/Abstract

摘要：

目的检索、评价并总结体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）清醒患者实施早期活动的最佳证据，为临床实践提供参考。方法检索UpToDate、BMJ Best Practice、加拿大安大略省注册护士协会网、指南网站（美国国立指南数据库、英国国家卫生与临床优化研究所指南库、医脉通）、澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute，JBI）循证卫生保健中心数据库、Cochrane Library、CINAHL、PubMed、中国生物医学文献数据库、中国知网、万方数据库、维普数据库及体外生命支持组织官方网站中关于ECMO清醒患者早期活动相关的指南、专家共识、证据总结、系统评价，并补充检索高质量的原始研究，检索时限为建库至2023年6月。文献的质量评价根据纳入文献类型所对应的质量评价工具进行评价。结果共纳入文献14篇，其中指南2篇，专家共识4篇，系统评价5篇，队列研究2篇，病例研究1篇。总结出33条证据，内容涉及实施ECMO清醒策略的适应条件、团队组成、综合评估、活动前准备、活动内容、不良事件防控、效果评价7个方面。结论该研究总结了ECMO清醒患者实施早期活动的最佳证据，建议建立ECMO清醒患者早期活动的专业化团队，应用最佳证据规范早期活动流程，制订个体化活动方案。

关键词: 体外膜肺氧合, 清醒, 早期活动, 护理, 证据总结

Abstract:

Objective To retrieve，evaluate and summarize the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation，and to provide a reference for clinical practice. Methods UpToDate，BMJ Best Practice，Registered Nurses’ Association of Ontario，National Guideline Clearinghouse，National Institute for Health and Care Excellence，Yimaitong，Joanna Briggs Institute Library，Cochrane Library，CINAHL，PubMed，SinoMed，CNKI，Wanfang Database，Vip Database and Extracorporeal Life Support Organization Website were researched to collect the literature，including clinical guidelines，expert consensuses，evidence summaries，systematic reviews，and well-designed original studies. The time limit for retrieval was until June 2023. The quality of literature and the level of evidence were evaluated by the evaluation criteria and evidence grading system of JBI Evidence-Based Health Care Center. Results 14 pieces of the literature were included，including 2 clinical guidelines，4 expert consensuses，5 systematic reviews，2 cohort studies and 1 case series. Totally 33 pieces of evidence were summarized，covering 7 aspects：adaptation conditions for the implementation of awake ECMO，team composition，comprehensive assessment，pre-mobilization preparation，mobilization content，prevention and control of adverse events，and effect evaluation. Conclusion The study summarizes the best evidence of early mobilization in awake patients on extracorporeal membrane oxygenation. It is suggested that medical institutions establish a professional team for the early mobilization of awake ECMO patients，apply the best evidence to standardize the early mobilization process，and formulate an individualized mobilization program.

Key words: Extracorporeal Membrane Oxygenation, Awake, Early Mobilization, Nursing, Evidence Summary

梁江淑渊, 曾妃, 兰美娟, 顾培培, 蔡凌云, 郭璐瑶, 朱岩, 郭鸽. 体外膜肺氧合清醒患者早期活动的最佳证据总结[J]. 中华护理杂志, 2024, 59(3): 345-352.

LIANG Jiangshuyuan, ZENG Fei, LAN Meijuan, GU Peipei, CAI Lingyun, GUO Luyao, ZHU Yan, GUO Ge. Evidence summary of early mobilization in awake patients on extracorporeal membrane oxygenation[J]. Chinese Journal of Nursing, 2024, 59(3): 345-352.

图/表 3

图1 文献筛选流程图注:NICE为英国国家卫生与临床优化研究所、JBI为乔安娜布里格斯研究所、ELSO为体外生命支持组织。

Figure 1 Literature screening process

表1 纳入文献的一般特征（n=14）

Table 1 General characteristics of the included literature （n=14）

表2 体外膜肺氧合清醒患者早期活动的最佳证据总结

Table 2 Evidence summary of early mobilization in awake patients on extracorporeal membrane oxygenation

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