气管插管非计划拔管危险因素的系统评价  

Risk factors of unplanned endotracheal extubation:a systematic review

作　　者：葛向煜[1] 徐建鸣[2] 朱晓玲[3] 胡雁[1] 秦薇[2] 潘文彦[3] 

机构地区：[1]复旦大学护理学院,上海200032 [2]复旦大学附属中山医院护理部 [3]复旦大学附属中山医院重症监护室

出　　处：《护理学杂志》2014年第1期80-84,共5页

基　　金：美国中华医学基金会(CMB)2010年护理青年教师科研基金项目(10-020-201105);复旦大学护理科研基金重点项目(FNSF201110)

摘　　要：目的系统评价国内外气管插管非计划拔管(UEX)的危险因素。方法计算机检索国内外知名数据库,纳入中英文发表的成人UEX危险因素的研究,进行Meta分析或描述性分析。结果纳入23篇病例对照/队列研究文献,1篇描述性研究文献及2篇案例系列报告文献,合计15 438例气管插管患者,1 376例UEX事件。Meta分析发现男性、经口插管是UEX危险因素,而烦躁、没有使用镇静剂、护士缺乏工作经验及没有标准的撤机流程亦有可能是导致UEX的危险因素。UEX高危时间段包括夜班、撤机阶段及交接班前后1h。较多患者在身体约束的情况下发生UEX。结论为降低UEX,需进一步规范身体约束及镇静管理,加强对高危人群和高危时间段的监护。Objective To assess the global risk factors of unplanned endotracheal extubation （UEX）. Methods A literature search was conducted in several famous database websites to locate all studies published in English or Chinese reporting the risk factors of UEX in adults. Data were synthesised using meta-analysis and descriptive analysis as appropriate. Results A total of 23 case-control/ cohort studies, 1 descriptive study and 2 case reports were eligible for analysis, involving 15,438 endotracheal intuhated patients and 1,376 UEX cases. Meta-analysis indicated that male and orotracheal intubation were risk factors of UEX. Anxiety, without sedation, shortage of experienced nurses, and lack of standard weaning protocol might be risk factors. The high risk periods of UEX were night shift, weaning process and 1 h before and after shift change. Many UEX cases were occurred in physically restrained patients. Conclusion Physical restraint use and sedation management should be standardized for UEX prevention, and monitoring of atrisk patients and during high-risk periods should be strengthened.

关 键 词：气管插管 非计划拔管 危险因素 系统评价 

分 类 号：R472[医药卫生—护理学]