ICU机械通气患者胸部物理治疗的最佳证据总结  

Best evidence for chest physiotherapy in ICU patients under mechanical ventilation

作　　者：唐志红 范美龄 李霞 周秋羊 李娜 田永明 Tang Zhihong;Fan Meiling;Li Xia;Zhou Qiuyang;Li Na;Tian Yongming(West China School of Nursing,West China Hospital,Sichuan University,Chengdu,610041,China)

机构地区：[1]四川大学华西护理学院/四川大学华西医院重症医学科,四川成都610041

出　　处：《现代临床护理》2023年第9期16-24,共9页Modern Clinical Nursing

基　　金：四川大学护理学科发展基金,项目编号为NO.HXHL21067。

摘　　要：目的检索并获取国内外关于重症监护病房(intensive care unit,ICU)机械通气患者胸部物理治疗的相关证据,并对最佳证据进行总结,为ICU机械通气患者的胸部物理治疗提供循证依据。方法系统检索Up to date,PubMed,Cochrane Library,JBI,CINAHL,BMJ,NICE,加拿大安大略护理学会网站(Registered Nurses’Association of Ontario,RNAO),美国指南网(National Guideline Clearinghouse,NGC),中国生物医学文献数据库(China Biology Medicine disc,CBM),Embase,Web of Science,医脉通,中国知网,万方,维普(VIP),美国呼吸病学会,美国重症医学会,欧洲危重病学会,中华医学会呼吸病学分会关于ICU机械通气患者胸部物理治疗的所有文献,包括指南、证据总结、专家共识、系统评价、临床决策、随机对照研究等,检索时限为2007年8月1日至2022年8月1日。由两名研究者对文献质量独立进行评价,对符合标准的文献进行证据提取。结果本研究共纳入文献22篇,包括指南5篇,专家共识4篇,临床决策3篇,系统评价10篇。最佳证据包括:评估与方案制定、体位管理、扣拍及震动技术、肺复张、呼吸肌训练策略、安全保障6个主题,17条证据。结论本研究提取的最佳证据可应用于ICU机械通气患者胸部物理治疗实践中,但要结合患者的实际情况,有针对地选择证据,使患者获取最佳的疗效。Objective To retrieve and summarise the best evidences for chest physiotherapy in ICU patients under mechanical ventilation at home and abroad.Methods Relevant literatures in chest physiotherapy for ICU patients with mechanical ventilation was systematically searched through databases from 1st August,2007 to 1st August,2022.The searched databases included:Up to date,PubMed,Cochrane Library,JBI,CINAHL,BMJ,NICE,RNAO,NGC,CBM,Embase,Web of Science,Chinese Medical Network,China National Knowledge Infrastructure,Wanfang Database,VIP,American Respiratory Association,American Society of Critical Care Medicine,European Society of Critical Illness and the Respiratory Branch of Chinese Medical Association.Expert consensus,guidelines,clinical decisions,systematic evaluations,evidence summaries,and randomised controlled studies were included in the searches.Two researchers independently evaluated the quality of the literatures and extracted evidences from the literatures that met the criteria.Results A total of 22 literatures were included,covering 5 guidelines,4 expert consensus,3 clinical decisions,and 10 systematic evaluations.After the expert evaluation,17 pieces of best evidence were summarised with 6 themes:evaluation and plan formulation,posture management,airway clearance therapy,lung recruitment,respiratory muscle training strategy and safety assurance.Conclusions The best evidence extracted in this study could be put on trial in the practice of chest physiotherapy in ICU patients under mechanical ventilation.However,the evidences should be selected accordingly based on the situations of individual patient in order to achieve the best therapeutic effect.

关 键 词：重症监护病房 机械通气 胸部物理治疗 证据总结 

分 类 号：R473.5[医药卫生—护理学]