不同吸痰深度对建立人工气道的成年患者吸痰效果系统评价  

Effects of Different Depth of Endotracheal Suctioning on Adult Patients with Artificial Airways:A Systematic Review

作　　者：梅彬彬[1] 殷庆梅[1] 王雯婷 崔飞飞 沈梅芬[1] MEI Bin-bin;YIN Qing-mei;WANG Wen-ting;CUI Fei-fei;SHEN Mei-fen(Dept.of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Dept.of Critical Care Medicine,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院神经外科,江苏苏州215006 [2]苏州大学附属第一医院重症医学科,江苏苏州215006

出　　处：《护理学报》2018年第5期36-42,共7页Journal of Nursing（China）

基　　金：江苏省卫生计生委2017年委医学科研课题(N2017010)

摘　　要：目的系统评价浅层、深层吸痰深度对建立人工气道的成年患者气道内吸痰效果的差异。方法计算机检索Pub Med、Embase、The Cochrane Library、中国期刊全文数据库,中国生物医学文献服务系统,万方数据资源系统,维普期刊资源整合服务平台数据库,收集成年患者浅层、深层吸痰比较的随机对照研究。使用Rev Man 5.3进行统计分析。结果初步检索获得文献2 732篇,最终纳入12项随机对照研究。Meta分析显示,相较深层吸痰,浅层吸痰法吸痰前后血氧饱和度的上升幅度(Z=9.18,P<0.01)、潮气量的增加幅度(Z=2.43,P=0.02)较大,血压波动(Z=4.28,P<0.01)、气道黏膜损伤发生率(Z=6.08,P<0.01)、刺激性咳嗽发生率(Z=3.23,P<0.01)较小,而两者在痰鸣音改善评分上差异无统计学意义,对气道峰压下降幅度、心率及VAP影响的结果稳定性较差。结论浅层吸痰法在改善血氧饱和度、增加潮气量、减轻气道损伤等方面优于深层吸痰,但两者在气道峰压、痰鸣音、VAP发生等方面暂未发现差异,尚需大量高质量的研究作进一步探讨。Objective To investigate the difference of shallow and deep endotracheal suctioning on the effectiveness of suctioning in adult patients with artificial airways.Methods We searched PubMed,Embase,the Cochrane Library,CNKI,CBM,Wanfang and VIP to collect randomized controlled trails(RCTs)and RevMan 5.3 was used for statistical analysis.Results Twelve studies were included and the results of meta analysis showed that,before and after sputum aspiration,compared with deep endotracheal suctioning,shallow endotracheal suctioning led to a greater increase in oxygen saturation(Z=9.18,P<0.01)and tidal volume(Z=2.43,P=0.02),and a lower incidence of blood pressure fluctuations(Z=4.28,P<0.01),airway mucosal injury(Z=6.08,P<0.01)and irritative cough(Z=3.23,P<0.01).Additionally,no statistically significant difference was found in the changes of phlegm sound score between two groups,and the results of the influence of shallow or deep endotracheal suctioning on airway peak,heart rate and VAP were unstable.Conclusion In terms of improving oxygen saturation,increasing tidal volume and alleviating airway injury,shallow endotracheal suctioning is superior to deep suction.However,no differences are found in airway peake,phlegm sound and VAP between shallow and deep endotracheal suctioning and a large number of high quality studies are still in needs to interpret the results.

关 键 词：浅层吸痰 深层吸痰 吸痰深度 人工气道 系统评价 

分 类 号：R473.56[医药卫生—护理学]