喉切除术后气管切开非机械通气病人气道湿化管理的最佳证据总结  

Summary of the best evidence for airway humidification management in non-mechanical ventilation patients with tracheotomy after laryngectomy

作　　者：罗明月 郑婷 潘乐 韩明华 段欣宇 丁永霞[1,3] LUO Mingyue;ZHENG Ting;PAN Le;HAN Minghua;DUAN Xinyu;DING Yongxia(School of Nursing,Shanxi Medical University,Shanxi 030001 China;First Affiliated Hospital of Shanxi Medical University;Evidence-Based Nursing Research Center of Shanxi Medical University)

机构地区：[1]山西医科大学护理学院,山西030001 [2]山西医科大学第一附属医院 [3]山西医科大学循证护理研究中心

出　　处：《循证护理》2025年第8期1468-1476,共9页Chinese Evidence-Based Nursing

基　　金：山西省基础研究计划自然科学研究面上项目,编号:202303021211121。

摘　　要：目的:更新、总结近5年内有关喉切除术后气管切开非机械通气病人气道湿化管理的相关证据。方法:依据“6S”证据金字塔模型从上至下检索BMJ Best Practice、Up To Date、澳大利亚Joanna Briggs Institute(JBI)循证卫生保健研究中心等国内外相关网站及数据库中关于喉切除术后气管切开非机械通气病人气道湿化管理的文献,检索时限为2018年12月—2024年6月;由2名研究者独立进行文献筛选、资料提取和证据汇总。结果:共纳入22篇文献,包括2篇指南、6篇专家共识、4篇证据总结、1篇循证实践、3篇Meta分析和6篇随机对照试验,最终形成了包括监测评估、体液管理、湿化方式、湿化装置、湿化装置固定、湿化液、查验评估和湿化操作8个主题共25条最佳证据。结论:本研究在既往研究的基础上补充提出了湿化方式的选择应综合考虑病人的呼吸功能、疾病状况、活动量以及痰液的性质、颜色和量等因素,人工气道吸痰前和吸痰期间不需要常规使用湿化液滴注,以及在无禁忌和经济限制的情况下优先推荐使用热湿交换器和标化弹力线固定法固定湿化管等新观点。建议今后应在综合考虑具体临床情境和病人意愿的基础上进行临床转化,以规范气道湿化管理流程,完善气道湿化管理措施。Objective:To update and summarize the relevant evidence on airway humidification management in patients undergoing tracheotomy without mechanical ventilation after laryngectomy in the past 5 years.Methods:Based on the"6S"evidence pyramid model,the literature on tracheal wetting management after laryngectomy from top to bottom in relevant websites and databases at home and abroad,such as the BMJ Best Practice,UpToDate,and the Joanna Briggs Institute Centre for Evidence-Based Health Care Research in Australia were searched literature on the management of airway wetting in patients with incision non-mechanical ventilation.The time frame for the search was from December 2018 to June 2024.Literature screening,data extraction and evidence summarization were performed independently by 2 researchers.Results:A total of 22 articles were included,including 2 guidelines,6 expert consensus articles,4 evidence summaries,1 evidence-based practice article,3 Meta-analyses,and 6 randomized controlled trials.Ultimately,a total of 25 best pieces of evidence were formed for 8 themes including monitoring and evaluation,fluid management,humidification methods,humidification devices,humidification device fixation,humidification fluids,inspection and evaluation,and humidification operations.Conclusions:On the basis of previous studies,this study proposes that the selection of humidification methods should comprehensively consider factors such as the patient's respiratory function,disease status,activity level,as well as the nature,color,and volume of sputum.Conventional use of humidification droplets is not necessary before and during artificial airway suction,and new perspectives such as prioritizing the use of heat and moisture exchangers and standardized elastic line fixation for humidification tubes are recommended without contraindications or economic limitations.It is suggested that in the future,clinical translation should be carried out based on comprehensive consideration of specific clinical situations and patient wishes,in ord

关 键 词：喉切除术 气管切开 非机械通气 气道湿化 证据总结 循证护理 

分 类 号：R473.73[医药卫生—护理学]