【摘要】：目的:通過對成人氣管插管患者發(fā)生非計劃性拔管的相關(guān)文章進行檢索、評定并進行系統(tǒng)評價,提出了成人氣管插管患者發(fā)生非計劃性拔管的危險因素的評估和預(yù)防策略,以期為臨床非計劃性拔管的評估和干預(yù)提供依據(jù)。方法:通過對 Cochrane、PubMed、SCOPUS、CINAHL、EBSCO、MEDLINE、CBM、CNKI中國知網(wǎng)、萬方等數(shù)據(jù)庫已經(jīng)公開發(fā)表的文獻數(shù)據(jù)進行檢索,檢索時限:2005年1月1日到2017年1月31日。檢索Cochrane圖書館是否有相關(guān)的系統(tǒng)評價、Meta分析,在各數(shù)據(jù)庫中檢索相關(guān)的原始文獻,對文獻的題目、摘要、關(guān)鍵詞、主題詞及參考文獻進行分析,確定文獻檢索的關(guān)鍵詞。主題詞與自由詞結(jié)合,及時參考檢索到的文獻,不斷擴充同義檢索詞。確定英文檢索詞:(unplanned extubation or unexpected extubation or unscheduled extubation or unintended extubation or inadvertent extubation or unintentional extubation or self-extubation or airway accident)and(mechanical ventilation or artificial respiration or intubation);中文檢索詞:非計劃性拔管OR意外拔管OR自行拔管。對檢索結(jié)果進行嚴(yán)格篩選,最后選出符合要求的文獻,由2位研究員采用美國約翰霍普金斯證據(jù)等級與質(zhì)量評價方法獨立對相關(guān)文獻進行等級和質(zhì)量評定,然后進行數(shù)據(jù)收集和分析。研究結(jié)果:納入50篇文獻的質(zhì)量與等級評定結(jié)果,Level ⅠB 1篇;Level ⅡA1篇;Level ⅡB 6篇;Level ⅢA 31篇;Level ⅢB 7篇;Level ⅣA 4篇,通過系統(tǒng)分析和歸納出成人氣管插管患者發(fā)生非計劃性拔管的危險因素和預(yù)防策略。危險因素包括患者相關(guān)的危險因素:躁動/譫妄、意識水平、疾病種類和嚴(yán)重程度、其他因素(APACHEⅡ、男性);護理相關(guān)的危險因素:氣管導(dǎo)管的固定方法、床邊監(jiān)測的減少、護理操作程序、護患比例及護士經(jīng)驗;鎮(zhèn)靜相關(guān)的危險因素:鎮(zhèn)靜不充分、鎮(zhèn)靜藥物;身體約束具的使用;發(fā)生非計劃性拔管的高危時間段。預(yù)防非計劃性拔管策略包括員工的教育策略;危險因素評估策略;氣管導(dǎo)管固定方法和監(jiān)測策略;鎮(zhèn)靜、鎮(zhèn)痛協(xié)議策略;撤機協(xié)議策略;身體約束具策略和管理策略。研究結(jié)論:建立一套成人氣管插管患者發(fā)生非計劃性拔管的危險因素的評估和預(yù)防非計劃性拔管策略,對降低氣管插管患者的非計劃性拔管發(fā)生是行之有效的方法。
[Abstract]:Objective: to evaluate and systematically evaluate the risk factors of unplanned extubation in adult patients with tracheal intubation by searching, evaluating and systematically evaluating the risk factors of unplanned extubation in adult tracheal intubation patients. In order to provide the basis for clinical unplanned extubation evaluation and intervention. Methods: through the retrieval of the published literature data of Cochrane,PubMed,SCOPUS,CINAHL,EBSCO,MEDLINE,CBM,CNKI China knowledge Network, Wanfang and other databases, the time limit of retrieval was from January 1, 2005 to January 31, 2017. Search the Cochrane library for systematic evaluation and meta analysis, search the related original documents in each database, analyze the titles, abstracts, keywords, subject words and references of the literature, and determine the keywords of the literature retrieval. Subject words combined with free words, timely reference to the retrieval of literature, expanding synonymous search words. Determine the English key word: (unplanned extubation or unexpected extubation or unscheduled extubation or unintended extubation or inadvertent extubation or unintentional extubation or self-extubation or airway accident) and (mechanical ventilation or artificial respiration or intubation);: unplanned extubation OR unintentional extubation OR self-extubation. The retrieval results were strictly screened, and the documents that met the requirements were selected. The relevant documents were evaluated independently by two researchers using the Johns Hopkins evidence rating and quality evaluation method in the United States. Data are then collected and analyzed. Results: the results of quality and grade evaluation of 50 articles included: level 鈪，

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