卒中后吞咽障碍患者卒中相关性肺炎预防的证据总结

doi:10.3761/j.issn.1672-9234.2021.03.013

摘要/Abstract

摘要：

目的总结、评价国内外关于卒中后吞咽障碍患者卒中相关性肺炎预防的最佳证据,为临床护理人员提供循证依据。方法检索UpToDate、BMJ best practice、Cochrane Library、苏格兰学院间指南网、中国生物医学文献数据库、万方数据库等,检索时间限制为建库至2020年5月6日,由2名研究者使用AGREE Ⅱ评价指南质量,使用JBI循证卫生保健中心对应的评价标准（2016）对系统评价、专家共识、队列研究及病例对照研究进行质量评价,并进行证据提取及汇总分析。结果本研究一共纳入14篇文献,包括9篇指南、1篇系统评价、2篇专家共识、1篇病例对照研究和1篇临床决策,共形成23条最佳证据,主要内容包括卒中相关性肺炎的诊断标准、危险因素、吞咽筛查及康复训练、误吸预防、口腔卫生及病情观察。结论本研究总结了吞咽障碍患者卒中相关性肺炎预防的最佳证据,为护理人员对吞咽障碍患者卒中相关性肺炎的预防工作提供科学的依据,由于本研究总结的证据来自多个国家,在应用前应进行充分的临床环境及其他相关因素的评估,以促进护理质量的提升。

关键词: 卒中, 吞咽障碍, 肺炎,吸入性, 循证实践

Abstract:

Objective To summarize and evaluate the best evidence for the prevention of stoke associated pneumonia（SAP） in patients with dysphagia. Methods We searched evidence in UpToDate,BMJ best practice,the Cochrane Library,Scottish Intercollegiate Guidelines Network,China Biology Medicine disc,Wanfang database from inception to May 6,2020. The quality assessment was conducted by two researchers using AGREE Ⅱ for guidelines and JBI evidence-based health care center evaluate standards（2016） for systematic review,expert consensus,cohort studies and case-control studies. Results A total of 14 articles were included in this study,including 9 guidelines,1 systematic review,2 expert consensus and 1 case-control study.Twenty-three pieces of the best evidence were extracted including the diagnostic criteria,risk factors,swallowing disorders management,aspiration prevention,oral hygiene and disease observation. Conclusion This study summarizes the best evidence of prevention of SAP in patients with dysphagia for clinical nursing staff. In order to promote nursing quality,clinical environment and other related factors should be assessed before application as the current study summarized the evidence from several countries.

Key words: Stroke, Deglutition Disorders, Pneumonia,Aspiration, Evidence-Based Practice

郭园丽, 马珂珂, 董小方, 杨彩侠, 王爱霞. 卒中后吞咽障碍患者卒中相关性肺炎预防的证据总结[J]. 中华护理教育, 2021, 18(3): 253-259.

GUO Yuan-li, MA Ke-ke, DONG Xiao-fang, YANG Cai-xia, WANG Ai-xia. Evidence summary of prevention of stroke associated pneumonia in patients with dysphagia[J]. Chinese Journal of Nursing Education, 2021, 18(3): 253-259.

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