护士主导的程序化撤机方案对ICU机械通气患者临床结局影响的系统评价  

The impact of nurse-led programmatic weaning protocol on mechanical ventilation outcomes in ICU patients:a systematic review

作　　者：巴桑康卓 孙建华 罗红波 李尊柱 洛桑旦增[1] 井杰 赵明曦 谢铃莉 姜淼 BASANG Kangzhuo;SUN Jianhua;LUO Hongbo;LI Zunzhu;LUOSANG Danzeng;JING Jie;ZHAO Mingxi;XIE Lingli;JIANG Miao

机构地区：[1]西藏自治区人民医院重症医学科,拉萨市850000 [2]中国医学科学院北京协和医院内科ICU [3]中国医学科学院北京协和医院重症医学科

出　　处：《中华急危重症护理杂志》2024年第12期1123-1129,共7页Chinese Journal of Emergency and Critical Care Nursing

基　　金：北京市科学技术委员会"首都临床诊疗技术研究及转化应用"项目(Z201100005520007);重症超声研究会超声专项研究课题(2022-CCUSG-A-03)。

摘　　要：目的 探讨以护士为主导的程序化撤机方案对ICU患者机械通气结局的有效性和安全性,以期为早期规范化撤离机械通气提供借鉴。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据库、中国生物医学文献数据库和维普数据库,检索时限均为从建库至2023年8月5日。由2名研究者独立筛选文献,提取数据,进行质量评价,采用RevMan 5.3软件进行Meta分析。结果 共纳入9篇文献,均为随机对照试验研究。Meta分析显示,以护士主导的程序化撤机方案可以缩短ICU患者机械通气时间[MD=-37.05,95%CI(-57.93,-16.16),P=0.005],减少ICU住院时间[MD=-5.58,95%CI(-9.91,-1.24),P=0.010],差异有统计学意义;但对患者病死率的影响差异无统计学意义[RR=1.00,95%CI(0.77,1.28),P=0.970]。结论 以护士主导的机械通气程序化撤机方案安全性较好,有助于缩短机械通气时间,降低ICU住院时间,为ICU患者机械通气的护理实践提供了证据。Objective To evaluate the effectiveness and safety of nurse-led programmatic weaning protocol on mechanical ventilation outcomes in Intensive Care Unit,so as to provide reference for early standardized weaning of mechanical ventilation.Methods PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure,WanFang Database,China Biomedical Literature Database,and VIP Database were retrieved.The search deadline was from database establishment to August 5,2023.Two researchers independently selected literature,extracted data,and evaluated the quality of the literature.RevMan 5.3 was used for meta-analysis.Results 9 randomized controlled trials were included.Meta-analysis showed that nurse-led programmatic ventilator weaning protocol could shorten mechanical ventilation time[MD=-37.05,95%CI(-57.93,-16.16),P=0.005]and reduce ICU hospitalization time[MD=-5.58,95%CI(-9.91,-1.24),P=0.010],with statistically significant differences.However,there was no statistically significant difference in patient mortality[OR=0.99,95%CI(0.70,1.42),P-0.9].Conclusion The nurse-led programmatic ventilator weaning protocol is safe and effective,which helps to shorten mechanical ventilation time,reduce ICU hospitalization time,and provides evidence for the nursing practice of mechanical ventilation for ICU patients.

关 键 词：重症监护病房 机械通气 循证护理学 系统综述 

分 类 号：R472.2[医药卫生—急诊医学]