Abstract:

Objective To evaluate the effect of awake prone positioning strategy in patients with acute hypoxemic respiratory failure（AHRF）. Methods 7 electric databases including the China National Knowledge Infrastructure（CNKI），Wanfang Database，VIP Database，PubMed，Embase，Web of Science，and Cochrane Library were systematically searched for randomized controlled trials and observations on awake prone positioning in patients with AHRF. The search time limit is from the establishment of the database to August 2022，and the references of the included literature are also traced. 2 researchers independently performed literature screening，data extraction and quality assessment according to the inclusion and exclusion criteria. Meta-analysis was performed by RevMan 5.3 software. Results 12 pieces of the literature were finally included，including 5 randomized controlled trials and 7 cohort studies，with a total of 2 632 patients. The results of Meta-analysis showed that the intubation rate of the awake prone positioning group was significantly different from that of the routine care group[RR=0.73，95%CI （0.65，0.82），P<0.001]；compared with those of the routine care group，the differences of the mortality rate[RR=0.87，95%CI(0.74，1.03), P=0.110] and hospital stay[MD=-1.05，95%CI(-4.22, 2.12),P=0.520] were not statistically significant. The secondary adverse effects to awake prone positioning were reported in 7 studies, including discomfort(8%~35%),pain(7%~11%),vomiting(2%~8%),catheter displacement(4%~6%),skin ulceration(0.4%~4.0%),hypotension(4%),venous thromboembolism(2.3%),cough(2%),and aspiration pneumonia(1.5%). The time range of a single prone position of the patients was quite different(1.25~15.00) h. Conclusion Awake prone positioning can effectively reduce the intubation rate of AHRF patients，but it cannot reduce the hospital stay of patients，and the impact on mortality needs further research and verification. Intolerance and pain were the most common adverse reactions when patients were in the prone position，affecting their compliance. Therefore，it is suggested that high-quality research should be carried out in the future，aiming at strengthening nursing management of awake prone positioning，improving patient compliance，and further improving the success rate of treatment.

Key words: Awake Prone Positioning, Acute Hypoxemic Respiratory Failure, Meta-Analysis, Evidence-based Nursing

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。

关键词: 清醒俯卧位通气, 急性低氧性呼吸衰竭, Meta分析, 循证护理学