气管插管拔管后吞咽障碍评估与干预的证据总结  

Evidence summary for the evaluation and intervention of Post-Extubation Dysphagia

作　　者：刘畅 陈岚[1] 袁梦湄 尹潇潇 田文浩 封秀琴[1] LIU Chang;CHEN Lan;YUAN Mengmei;YIN Xiaoxiao;TIAN Wenhao;FENG Xiuqin(Nursing Department,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou,310009,China)

机构地区：[1]浙江大学医学院附属第二医院护理部,杭州市310009 [2]金华市中心医院重症医学科

出　　处：《中国护理管理》2025年第1期69-75,共7页Chinese Nursing Management

基　　金：浙江大学“双一流”建设护理优势特色学科科研培育基金(HL2024029)。

摘　　要：目的:检索、评价并整合气管插管患者拔管后吞咽障碍评估与干预的证据,为临床实践提供参考。方法:按照“6S”金字塔证据模型,在相关指南网站及中、英文数据库中系统检索国内外关于气管插管拔管后吞咽障碍评估与干预的临床决策、最佳实践、指南、系统评价、证据总结、专家共识、专家意见以及随机对照试验,文献检索时限为建库至2024年6月6日。对纳入文献进行质量评价,提取证据并汇总分级。结果:共纳入29篇文献,其中2篇临床决策、3篇指南、8篇系统评价、2篇证据总结、7篇随机对照试验、6篇专家共识和1篇专家意见,最终形成多学科协作、筛查评估、康复训练、进食管理、健康教育5个主题,25条证据。结论:本研究总结的证据可用于有效评估并改善PED患者的吞咽功能。在后续证据转化时,医护人员应结合国内临床情境及个体情况为患者制订个性化的实施方案。Objective:To systematically retrieve,integrate and analyze the relevant evidence for the evaluation and intervention of Post-Extubation Dysphagia(PED),and to provide the best evidence for clinical practice.Methods:A systematic search was conducted in accordance with the"6S"pyramid evidence model across relevant guideline websites and databases both at home and abroad from their inception to June 6,2024.The search focused on clinical decision-making,best practices,guidelines,systematic reviews,evidence summaries,expert consensus,expert opinion and randomized controlled trials(RCTs)which were related to the assessment and intervention of PED.Evidence was extrated and integrated after quality evaluation of the included studies.Results:A total of 29 studies were included in the final analysis:2 clinical decision-making studies,3 guidelines,8 systematic reviews,2 evidence summaries,7 RCTs,6 expert consensus documents,and 1 expert opinion.The evidence synthesis led to the identification of 25 best practices,which were organized into five key themes:multidisciplinary collaboration,screening and assessment,rehabilitation training,feeding management,and health education.Conclusion:The study summarizes the evidence for improving the swallowing function of patients with PED.When apply the evidence to clinical nursing,health professionals should formulate a personalized plan according to the patients'situation and characteristics.

关 键 词：气管插管 拔管后吞咽障碍 证据总结 循证护理 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]