以质量求发展，以服务铸品牌

护理学报 ›› 2021, Vol. 28 ›› Issue (13): 46-51.doi: 10.16460/j.issn1008-9969.2021.13.046

• 循证护理 • 上一篇    下一篇

气管切开术后非机械通气患儿早期气道并发症预防的最佳证据总结

吕云霞a, 冯少娟a, 刘正伟b, 陈彦球a, 刘洁a, 黄洁莹a   

  1. 广州市妇女儿童医疗中心 a.外科八区; b.心血管科,广东 广州 510623
  • 收稿日期:2021-03-07 发布日期:2021-08-06
  • 通讯作者: 冯少娟（1974-）,女,广东广州人,本科学历,主管护师,护士长。E-mail:fsj@163.com
  • 作者简介:吕云霞（1987-）,女,河南周口人,硕士,主管护师。
  • 基金资助:
    广州市妇女儿童医疗中心护理内部科研基金（HLB-2020-15）

Best Evidence Summary for Prevention of Early Airway Complications in Children with Non-mechanical Ventilation after Tracheotomy

LV Yun-xiaa, FENG Shao-juana, LIU Zheng-weib, CHEN Yan-qiua, LIU Jiea, HUANG Jie-yinga   

  1. a. Dept. of General Surgery, Section VIII; b. Dept. of Cardiology, Guangzhou Women and Children's Medical Center,Guangzhou 510623, China
  • Received:2021-03-07 Published:2021-08-06

PDF (PC)

135

赞

摘要： 目的 检索并总结气管切开术后非机械通气患儿早期气道并发症预防的相关证据,为临床提供参考。 方法 按照PIPOST方法确定循证问题,依据证据的6S模型针对气管切开术后非机械通气患儿早期气道并发症的预防开展系统性检索,包括计算机决策、临床指南、专家共识、证据总结、最佳实践推荐、系统评价。检索时限为从建库至2020年4月1日。由2名研究者分别对文献质量进行评价和证据提取。 结果 共纳入文献11篇,其中指南1篇,证据总结2篇,推荐实践3篇,专家共识5篇;结合专业人员的判断,从患者管理、气管造瘘口的维护、固定带的更换、气道吸引、气道湿化、气管套管的更换6个方面进行证据总结,汇总了37条最佳证据。 结论 临床管理者应该重视对气管切开术后患儿的管理,制定儿科气管切开术后非机械通气期间早期气道护理的标准化方案,并对所有医护人员进行培训,规范气道护理操作,降低气道并发症的发生率。

关键词: 气管切开术, 儿童, 非机械通气, 气道护理, 并发症, 循证护理

Abstract: Objectives To search and summarize the best evidence regarding the prevention of early airway complications in children with non-mechanical ventilation after tracheostomy, and to provide reference for clinical staffs. Methods Evidence-based problems were identified with PIPOST method and systematic literature retrieval was carried out on the basis of 6S evidence model. The evidence regarding prevention of early airway complications in children with non-mechanical ventilation after tracheostomy was searched. It included computer decision system, guidelines, expert consensus, evidence summaries and best practice recommendations, and systematic reviews. Two researchers assessed the quality and extract evidence independently. The retrieval time was from the inception to April 1, 2020. Results A total of 11 articles were selected including 1 guideline, 2 evidence summary, 3 recommended practices and 5 expert consensus. According to professional judgment, 37 pieces of best evidences were summarized into 6 aspects: patient management, tracheostoma care, tape changing, tracheal suction, humidification and tracheostomy tubes changing. Conclusion Clinical managers should strengthen the management after tracheotomy in pediatric patients and develop a standardized care program to standardize nursing procedure, thus to reduce the incidence of airway complications.

Key words: tracheostomy, child, non-mechanical ventilation, airway nursing, complication, evidence-based nursing

中图分类号: 

  • R473.6
[1] 韩东一,肖水芳.耳鼻咽喉头颈外科学[M].北京:人民卫生出版社,2017:513.
[2] 郑迎,王文超,张燕红,等.气管切开患儿延续性护理研究进展[J].护理学报,2017,24(20):29-33.DOI:10.16460/j.issn1008-9969.2017.20.029.
[3] Avelino MAG, Maunsell R, Valera FCP, et al.First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology(ABOPe) and Brazilian Society of Pediatrics (SBP)[J]. Braz J Otorhinolaryngol, 2017,83(5):498-506.DOI:10.1016/j.bjorl.2017.06.002.
[4] 李勤,沈伟.儿童气管切开术有关问题探讨[J].医学综述, 2006,12(9):564-566.DOI:10.3969/j.issn.1006-2084.2006.09.023.
[5] Sherman JM, Davis S, Albamonte-Petrick S, et al.Care of the Child with a Chronic Tracheostomy. This Official Statement of the American Thoracic Society was Adopted by the ATS Board of Directors, July 1999[J].Am J Respir Crit Care Med, 2000,161(1):297-308.DOI:10.1164/ajrccm.161.1.ats1-00.
[6] de Trey L, Niedermann E, Ghelfi D, et al. Pediatric Tracheotomy: A 30-year Experience[J]. J Pediatr Surg, 2013,48(7):1470-1475.DOI:10.1016/j.jpedsurg.2012.09.066.
[7] Ilce Z, Celayir S, Tekand GT, et al.Tracheostomy in Childhood:20 Years Experience from a Pediatric Surgery Clinic[J]. Pediatr Int, 2002,44(3):306-309.DOI:10.1046/j.1442-200x.2002.01554.x.
[8] 黄东海,肖健云,赵素萍,等.小儿气管切开术156例分析[J].临床耳鼻咽喉科杂志,2005(8):353-355. DOI:10.3969/j.issn.1001-1781.2005.08.008.
[9] 吴柳青,梁正中,唐向荣. 小儿气管切开术并发症原因分析[J]. 山东大学耳鼻喉眼学报, 2007(2):163-165. DOI:10.3969/j.issn.1673-3770.2007.02.025.
[10] 冯勇,奚玲,余晓旭,等.小儿气管切开术33例临床分析[J]. 临床耳鼻咽喉头颈外科杂志, 2013,27(2):98-100. DOI:1001-1781(2013)02-0098-03.
[11] Das P, Zhu H, Shah R K, et al.Tracheotomy-related Catastrophic Events: Results of a National Survey[J]. Laryngoscope, 2012,122(1):30-37.DOI:10.1002/lary.22453.
[12] Hopkins C, Whetstone S, Foster T, et al.The Impact of Tracheostomy on Both Patient and Parent[J]. Int [J] Pediatr Otorhinolaryngol.2009,73:15-20.DOI:10.1016/j.ijporl.2008.09.010.
[13] Doherty C, Bowler M, Monks S, et al.Reduction in Harm from Tracheostomy-related Incidents after Implementation of the Paediatric National Tracheostomy Safety Project Resources: A Retrospective Analysis from a Tertiary Paediatric Centre[J].Clin Otolaryngol, 2018,43(2):674-678.DOI:10.1111/coa.12994.
[14] 胡艳,王海燕,袁映红,等.集束化护理对气管切开患者切口感染的预防效果评价[J].中华医院感染学杂志,2015,10:2337-2339. DOI:10.11816/cn.ni.2015-150379.
[15] 中华护理学会.气管切开非机械通气患者气道护理[EB/OL]. (2020-01-03)[2020-3-15]. http://www.zhhlxh.org.cn/cnaWebcn/upFilesCenter/upload/file/20200103/1578033685394056751.pdf.
[16] 朱政,胡雁,邢唯杰,等.不同类型循证问题的构成[J].护士进修杂志,2017,32(21):1991-1994.DOI:10.16821/j.cnki.hsjx.2017.21.025.
[17] Dicenso A, Bayley L, Haynes RB.Accessing Pre-appraised Evidence: Fine-tuning the 5S Model into a 6S Model[J]. Evid Based Nurs, 2009,12(4):99-101.DOI:10.1136/ebn.12.4.99-b.
[18] AGREE. Appraisal of Guidelines for Research Evaluation II[EB/OL]. (2017-10-15)[2020-4-25]. https://www.agreetrust.org/wp-content/uploads/2017/12/AGREE-II-Users-Manual-and-23-item-Instrument-2009-Update-2017.pdf.
[19] 吕永利,李沙沙,李霞,等.宫颈癌患者根治术后尿潴留预防及管理的最佳证据总结[J].中华护理杂志, 2019,54(7):1097-1102. DOI:10.3761/j.issn.0254-1769.2019.07.028.
[20] Joanna Briggs Institute.Critical Appraisal Tools[EB/OL].[2020-04-15].https://joannabriggs.org/ebp/critical_appraisal_tools.
[21] Joanna Briggs Institute.JBI Critical Appraisal Checklist for Text and Opinion Papers[EB/OL].[2020-4-25].https://joan-nabriggs.org/sites/default/files/2019-05/JBI_Critical_Appraisal -Checklist_for_Text_and_Opinion2017_0.pdf.
[22] Joanna Briggs Institute.JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses[EB/OL]. [2020-04-15].https://joannabriggs.org/sites/default/files/2019-05/JBI_ Critical_ Appraisal- Checklist_for_ Systematic_Reviews 2017_0.pdf.
[23] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964-967. DOI:1002-6975(2015)11-0964-04.
[24] 米元元,沈月,郝彬,等. ICU患者肠内营养支持并发腹泻的循证护理实践[J]. 中华护理杂志, 2017,52(11):1291-1298. DOI:10.3761/j.issn.0254-1769.2017.11.002.
[25] Doherty C, Neal R, English C, et al.Multidisciplinary Guidelines for the Management of Paediatric Tracheostomy Emergencies[J]. Anaesthesia, 2018,73(11):1400-1417.DOI:10.1111/anae.14307.
[26] MPhil DE. Tracheostomy: Dressing[EB/OL]. (2019-07-17)[2020-04-25]. http://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=MDFOFPPCEGEBAPHLIPPJNFOGECDHAA00&Complete+Reference=S.sh.18%7c1%7c1&Counter5=SS_view_found_complete%7cJBI13840%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI13840%7cjbi%7cjbidb%7cjbi.
[27] Sivapuram MS. Tracheostomy: Management of Patients[EB/OL]. (2019-07-04)[2020-04-25]. http://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=DNHOFPOCIGEBAPOKJPPJPFBFEHPOAA00&Complete+Reference=S.sh.18%7c1%7c1&Counter5=SS_view_found_complete%7cJBI244%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI244%7cjbi%7cjbidb%7cjbi.
[28] The Joanna Briggs Institute. Tracheostomy: Suctioning[EB/OL]. (2019-01-23)[2020-04-25]. http://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=DNHOFPOCIGEBAPOKJPPJPFBFEHPOAA00&Complete+Reference=S.sh.36%7c1%7c1&Counter5=SS_view_found_complete%7cJBI2491%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI2491%7cjbi%7cjbidb%7cjbi.
[29] The Joanna Briggs Institute. Tracheostomy: Immediate Postoperative Care[EB/OL]. (2019-07-04)[2020-04-25]. http://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=HDPJFPECBPEBAPLBIPPJFGOGBAIOAA00&Complete+Reference=S.sh.35%7c1%7c1&Counter5=SS_view_found_complete%7cJBI1868%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI1868%7cjbi%7cjbidb%7cjbi.
[30] The Joanna Briggs Institute. Tracheostomy: Tape Changing[EB/OL].(2016-09-15)[2020-04-25].http://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi?&S=DNHOFPOCIGEBAPOKJPPJPFBFEHPOAA00&Complete+Reference=S.sh.40%7c1%7c1&Counter5=SS_view_found_complete%7cJBI2354%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI2354%7cjbi%7cjbidb%7cjbi.
[31] Mitchell RB, Hussey HM, Setzen G, et al.Clinical Consensus Statement: Tracheostomy Care[J]. Otolaryngology Head and Neck Surg,2012,148(1):6-20.DOI:10.1177/0194599812460376.
[32] Strychowsky JE, Albert D, Chan K, et al.International Pediatric Otolaryngology Group (IPOG) Consensus Recommendations: Routine Peri-operative Pediatric Tracheotomy Care[J]. Int J Pediatr Otorhinolaryngol, 2016(86):250-255.DOI:10.1016/j.ijporl.2016.03.029.
[33] Yue M, Lei M,Liu Y,et al.The Application of Moist Dressings in Wound Care for Tracheostomy Patients: A Meta-analysis[J]. J Clin Nurs, 2019,28(15-16):2724-2731.DOI:10.1111/jocn.14885.
[34] Russell C.Providing the Nurse with a Guide to Tracheostomy Care and Management[J]. Br J Nurs, 2005,14(8):428-433.DOI:10.12968/bjon.2005.14.8.17934.
[35] Barnett M.A Practical Guide to the Management of a Tracheostomy[J]. J Community Nurs, 2008,22(12):24-26.
[36] Dennis-Rouse MD, Davidson JE.An Evidence-based Evaluation of Tracheostomy Care Practices[J]. Crit Care Nurs Q,2008,31(2):150-160.DOI:10.1097/01.CNQ.0000314475.56754.08.
[37] Higgins D.Tracheostomy Care 3-Dressing[J].Nurs Times,2009,105(6):12-13.DOI:10.7748/ns.30.30.34.s44.
[1] 李萍, 靳小雯, 李燕玲, 徐玉兰, 喻姣花, 李卓颖, 李应, 邓睿. 成年患者结直肠镜检查肠道准备不充分的预防及管理证据总结[J]. 护理学报, 2021, 28(9): 22-28.
[2] 奉琴, 冯先琼, 何其英, 范冬萍, 邓兰. 移动管理方案在膀胱癌行回肠膀胱造口患者中的应用研究[J]. 护理学报, 2021, 28(6): 61-64.
[3] 杨巾夏, 姚文英, 王新. 对学龄期哮喘患儿实施儿童医疗辅助服务的效果观察[J]. 护理学报, 2021, 28(6): 71-75.
[4] 高兴莲, 余文静, 肖瑶, 胡娟娟, 赵诗雨, 杨英. 手术患者围术期压力性损伤预防及管理最佳证据总结[J]. 护理学报, 2021, 28(6): 22-26.
[5] 朱玮玮, 许阳子, 霍婉君, 陈慈玉, 李远添, 凌冬兰. 老年痴呆患者疼痛评估及管理最佳证据总结[J]. 护理学报, 2021, 28(5): 32-37.
[6] 严佳丽, 裘慧颖, 贾芸, 刘倩静, 富晶晶, 金云秋. 模拟体验并发症健康教育在中青年初发2型糖尿病患者中的应用[J]. 护理学报, 2021, 28(5): 75-78.
[7] 王亚玲, 王冰寒, 张艳, 尹雪, 蒋辛, 熊晓明, 黎华丽. 急性缺血性脑卒中患者溶栓术后预防出血转化的最佳证据总结[J]. 护理学报, 2021, 28(3): 46-52.
[8] 张颖, 王晓玲, 杨婷, 尹专叶, 胡雁. 住院成人患者血压测量袖带尺寸选择的最佳证据总结[J]. 护理学报, 2021, 28(14): 22-25.
[9] 付小霞, 米元元, 张淑梅, 朱丽群, 包磊, 郑兰平, 史红艳, 李渴望, 刘转巧, 温雅娜. 重大传染病疫情标本采集技术的最佳证据总结[J]. 护理学报, 2021, 28(14): 26-34.
[10] 邹兰娟, 宋亚敏, 凌云. 5例儿童心脏移植术后应用ECMO辅助的护理[J]. 护理学报, 2021, 28(12): 62-64.
[11] 张岚, 乐琼, 罗黎, 米元元, 刘亚兰, 吴丽芬, 邵俊, 郑兰. 新生儿院际转运管理的最佳证据总结[J]. 护理学报, 2021, 28(11): 21-26.
[12] 赵梓佳, 赵丹, 陈碧贤, 林燕群, 曾少珊, 凌冬兰. 术后恶心和呕吐非药物管理的最佳证据总结[J]. 护理学报, 2021, 28(11): 33-39.
[13] 张玉坤, 王钰炜, 王飒, 闫丹萍, 陈水红. 成人ICU患者疼痛管理的最佳证据总结[J]. 护理学报, 2021, 28(11): 40-45.
[14] 王润, 周春兰, 玉美, 周君桂, 刘瑜, 杨丽潇, 叶孝灵. 卒中后失语患者言语康复管理的证据总结[J]. 护理学报, 2021, 28(11): 16-20.
[15] 李娥, 严秋萍. 68例患儿心外膜永久起搏器植入术后并发症观察与护理[J]. 护理学报, 2021, 28(10): 72-74.
Viewed
Full text


Abstract

Cited
  Shared   
[1] 刘瑾, 路娜, 张凤娃, 牛晓丹, 袁蓉敬, 李雯艳, 王叶同, 王艳红. 乳腺癌患者癌症复发恐惧影响因素的Meta分析[J]. 护理学报, 2021, 28(14): 1 -7 .
[2] 蒙艺, 孙家乐, 谭静. 澳大利亚喘息服务的特征与启示[J]. 护理学报, 2021, 28(14): 64 -68 .
[3] 宋姗, 魏琳, 刘杨晨, 王秋婷, 罗尧岳, 林美珍. 基于数据包络分析法的护理人力资源效率评价[J]. 护理学报, 2021, 28(13): 1 -5 .
[4] 丁寒琴, 李立华, 何夏君. 精神科护士护理面谈能力培训体系的构建及信效度检验[J]. 护理学报, 2021, 28(13): 6 -12 .
[5] 张丽秀, 樊落, 李琳, 王雪, 魏婧昀, 冯兰棱. 急诊护理质量敏感指标的构建研究[J]. 护理学报, 2021, 28(13): 13 -18 .
[6] 王宁, 吕琳, 耿晨, 杨艳林, 苗丽珍, 韩琳. 伤口造口专科护理敏感质量指标研究进展及改进策略[J]. 护理学报, 2021, 28(13): 19 -23 .
[7] 侯坤华, 李芊芊, 彭燕秋, 杨雨晴, 赵海平. 预防性吞咽训练在头颈部肿瘤放化疗患者的应用进展[J]. 护理学报, 2021, 28(13): 24 -28 .
[8] 吕永利, 王焕焕, 李沙沙, 万丞, 吴佩. 腹腔镜下宫颈癌根治术后尿潴留预防和管理的循证护理实践[J]. 护理学报, 2021, 28(13): 29 -33 .
[9] 邓杨清, 潘岑, 王庆兰, 王迪. 乳腺癌患者运动体验质性研究的Meta整合[J]. 护理学报, 2021, 28(13): 34 -39 .
[10] 邓博, 刘宁, 杨琳. 临床实践项目持续性评估工具的范围综述[J]. 护理学报, 2021, 28(13): 40 -45 .