摘要
目的系统整合脑卒中气管切开(TAS)患者肺康复护理的最佳证据,为临床实践提供循证依据。方法遵循循证医学方法,系统检索UpToDate、BMJ Best Practice、PubMed、中国知网、万方医学网、维普数据库及中国生物医学文献数据库中关于TAS患者肺康复护理的相关文献。文献类型包括指南、专家共识、系统评价、meta分析、证据总结及原始研究,检索时限从建库到2025年1月。由2名研究人员独立完成文献质量评价,采用指南研究与评价工具-Ⅱ和澳大利亚乔安娜·布里格斯研究所文献质量评价工具进行方法学质量评估,最终分级整合符合标准的证据资料。结果共纳入文献20篇,包括指南6篇、专家共识5篇、meta分析4篇、临床决策3篇、系统评价1篇、随机对照试验1篇。形成32条推荐意见,涵盖气道管理(8项)、综合肺康复训练(8项)、基础治疗(5项)、安全管理(4项)、拔管护理(3项)及围拔管期并发症的预防(4项)6个维度,证据等级涵盖A级(强推荐)至B级(推荐)。结论本研究通过循证方法对TAS患者肺康复护理的核心要素进行系统整理,形成的多维度证据体系可为改善患者呼吸功能、降低并发症发生风险、优化拔管决策提供科学依据,并建议临床结合具体情况进行本土化应用。
Objective To systematically integrate the best evidence on pulmonary rehabilitation nursing for patients with tracheostomy after stroke(TAS),so as to provide evidence-based basis for clinical practice.Methods Following evidence-based medicine principles,we conducted a systematic search of literatures related to pulmonary rehabilitation nursing for patients with TAS in databases including UpToDate,BMJ Best Practice,PubMed,China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP Database,and China Biology Medicine(CBM).Literature types included guidelines,expert consensus,systematic reviews,meta-analyses,evidence summaries,and original studies,with the search period spanning from the inception of the database to Jan.2025.Two researchers independently assessed the quality of the included literatures using standardized tools such as Appraisal of Guidelines for Research and Evaluation-Ⅱand Joanna Briggs Institute tools,followed by grading and synthesizing evidences meeting the criteria.Results A total of 20 articles were included,including 6 guidelines,5 expert consensuses,4 meta-analyses,3 clinical decision-making papers,1 systematic review,and 1 randomized controlled trial.A total of 32 recommendations were formed,covering 6 dimensions:airway management(8 items),comprehensive pulmonary rehabilitation training(8 items),basic treatment(5 items),safety management(4 items),extubation nursing(3 items)and prevention of complications during the peri-extubation period(4 items).The evidence grades ranged from grade A(strong recommendation)to grade B(recommendation).Conclusion This study systematically synthesizes core elements of pulmonary rehabilitation nursing for patients with TAS through evidence-based methodology.The established multidimensional evidence framework provides scientific guidance for improving respiratory function,reducing complications,and optimizing extubation decisions.Clinicians are advised to adapt these recommendations to local contexts for practical implementation.
作者
李科欣
王琴
周荣慧
史瑶
顾君君
LI Kexin;WANG Qin;ZHOU Ronghui;SHI Yao;GU Junjun(Intensive Care Unit,Department of Cardiovascular Surgery,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China;Neurovascular Center,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China;Intensive Care Unit,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)
出处
《海军军医大学学报》
北大核心
2025年第9期1127-1137,共11页
Academic Journal of Naval Medical University
基金
海军军医大学深蓝护理科研一般项目(2022KYG23)。
关键词
脑卒中
气管切开术
肺康复
循证护理
证据总结
stroke
tracheostomy
pulmonary rehabilitation
evidence-based nursing
evidence summary
