俯卧位通气患者压力性损伤预防的最佳证据总结

doi:10.3761/j.issn.1672-9234.2021.10.015

摘要/Abstract

摘要：

目的总结国内外预防俯卧位通气患者压力性损伤的相关证据。方法系统检索UpToDate、英国国家健康和保健医学研究所、BMJ最佳临床实践、美国伤口造口失禁护理学会、Cochrane Library、PubMed、中国知网等数据库的相关指南、系统评价、专家共识和证据总结,采用澳大利亚JBI循证卫生保健中心的文献评价标准和证据分级系统,对不同类型研究分别进行文献质量评价及证据级别评定。结果本研究共纳入10篇文献,其中指南5篇、系统评价2篇、专家共识1篇、证据总结2篇。最佳证据包括风险评估、皮肤和组织评估、体位变换、皮肤保护、医疗器械相关性压力性损伤的预防、监管与培训6个方面,共30条。结论医务人员应结合临床情境按照相关级别的循证医学证据,选择有针对性的最佳证据,规范俯卧位通气患者的管理,减少相关压力性损伤的发生,提高护理质量。

关键词: 压力性溃疡, 俯卧位通气, 预防, 循证护理

Abstract:

Objective To summarize the best evidence of prevention of pressure ulcer in patients with prone position ventilation. Methods We systematically searched for evidence in UpToDate,National Institute for Health and Care Excellence,British Medical Journal Best Practice,Wound,Ostomy and Continence Nurses Society,Cochrane Library,PubMed,CNKI,etc. Guidelines,systematic evaluation,expert consensus and evidence summary were all collected. Results A total of 10 articles were included,including 5 guidelines,2 systematic evaluations,1 expert consensus,and 2 evidence summary. The best evidence included risk assessment,skin and tissue assessment,repositioning,skin protection,prevention of pressure injury related to medical devices,supervision and training with a total of 30 items. Conclusion Medical staff should select the best tailored evidence according to the evidence level. Besides,they should also standardize the management of patients with prone ventilation,reduce the occurrence of related pressure ulcer,and improve the quality of care.

Key words: Pressure Ulcer, Prone position ventilation, Prevention, Evidence-based nursing

彭操,陈秀文,任华,鄢斌,黄又喜. 俯卧位通气患者压力性损伤预防的最佳证据总结[J]. 中华护理教育, 2021, 18(10): 935-941.

PENG Cao,CHEN Xiu-wen,REN Hua,YAN Bin,HUANG You-xi. Evidence summary for prevention of pressure ulcer in patients with prone position ventilation[J]. Chinese Journal of Nursing Education, 2021, 18(10): 935-941.

图/表 3

参考文献 28

[1]	European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers /injuries:clinical practice guideline[S]. EPUAP /NPIAP /PPPIA, 2019.
[2]	Moore Z, Patton D, Avsar P, et al. Prevention of pressure ulcers among individuals cared for in the prone position:lessons for the COVID-19 emergency[J]. J Wound Care, 2020, 29(6):312-320. doi: 10.12968/jowc.2020.29.6.312 pmid: 32530776
[3]	Haleem S, Mihai R, Rothenfluh DA, et al. Preventing iatrogenic facial pressure ulcers during spinal surgery:prospective trial using a novel method and review of literature[J]. Int Wound J, 2020, 17(5):1391-1395. doi: 10.1111/iwj.v17.5
[4]	Girard R, Baboi L, Ayzac L, et al. The impact of patient positioning on pressure ulcers in patients with severe ARDS:results from a multicentre randomised controlled trial on prone positioning[J]. Intensive Care Med, 2014, 40(3):397-403. doi: 10.1007/s00134-013-3188-1
[5]	Sud S, Friedrich JO, Adhikari NK, et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome:a systematic review and meta-analysis[J]. J De L’association Med Can, 2014, 186(10):E381-E390.
[6]	Lucchini A, Bambi S, Mattiussi E, et al. Prone position in acute respiratory distress syndrome patients:a retrospective analysis of complications[J]. Dimens Crit Care Nurs, 2020, 39(1):39-46. doi: 10.1097/DCC.0000000000000393 pmid: 31789984
[7]	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.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[8]	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 pmid: 19779069
[9]	Hoffmann-Eβer W, Siering U, Neugebauer EA, et al. Guideline appraisal with AGREE II:systematic review of the current evi-dence on how users handle the 2 overall assessments[J]. PLoS One, 2017, 12(3):e0174831. DOI: 10.1371/journal.pone.0174831. doi: 10.1371/journal.pone.0174831
[10]	The Joanna Briggs Institute(JBI). Critical appraisal tools[EB/OL].(2017-07-15)[2020-09-01]. http://joannabriggs.org/research/critical-appraisal-tools.html.
[11]	余文静, 肖瑶, 胡娟娟, 等. 预防围手术期患者低体温的最佳证据总结[J]. 中华护理杂志, 2019, 54(4):589-594.
	Yu WJ, Xiao Y, Hu JJ, et al. Evidence summary for prevention of perioperative hypothermia in patients[J]. Chin J Nurs, 2019, 54(4):589-594.
[12]	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.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[13]	Wound,Ostomy and Continence Nurses Society-Wound Guide-lines Task Force. WOCN 2016 guideline for prevention and management of pressure injuries(ulcers):an executive summary[J]. J Wound Ostomy Continence Nurs, 2017, 44(3):241-246. doi: 10.1097/WON.0000000000000321
[14]	National Institute for Health and Care Excellence. Pressure ulcers:prevention and management[EB/OL]. [2020-09-01]. https://www.nice.org.uk/guidance/cg179/resources/pressure-ulcers-preven-tion-and-management-pdf-35109760631749.
[15]	Intensive Care Society. Prone positioning in adult critical care[EB/OL]. [2020-09-01]. https://www.ficm.ac.uk/sites/default/files/prone_position_in_adult_critical_care_2019.pdf.
[16]	Tissue Viability Society. Pressure ulcer prevention guidance when nursing patients in the prone position[EB/OL]. [2020-09-01]. https://tvs.org.uk/wp-content/uploads/2020/05/Pressure-ulcer-prevention-guidance-when-proning-patients-V5-17th-April-2020-1.pdf.
[17]	Bloomfield R, Noble DW, Sudlow A. Prone position for acute respiratory failure in adults[J]. Cochrane Database Syst Rev, 2015(11):CD008095.
[18]	汪晖, 曾铁英, 吴欣娟, 等. 重型危重型新型冠状病毒肺炎患者整体护理专家共识[J]. 中华护理杂志, 2020, 55(3):337-342.
	Wang H, Zeng TY, Wu XJ, et al. Holistic care for patients with severe coronavirus disease 2019:an expert consensus[J]. Chin J Nurs, 2020, 55(3):337-342.
[19]	Atul M, Robert MK. Prone ventilation for adult patients with acute respiratory distress syndrome[EB/OL].(2020-04-21)[2020-08-01]. http://222.247.54.203:1057/contents/prone-ventilation-for-adult-patients-with-acute-respiratory-distress-syndrome?search=pressure%20sores%20and%20prone%20ventilation&source=Out%20of%20date%20-%20zh-Hans&selectedTitle=1~150.
[20]	Dan Berlowitz. Prevention of pressure-induced skin and soft tissue injury[EB/OL].(2020-01-06)[2020-09-01]. http://222.247.54.203:1057/contents/prevention-of-pressure-induced-skin-and-soft-tissue-injury?search=%E5%8E%8B%E7%96%AE&source=Out%20of%20date%20-%20zh-Hans&selectedTitle=5~150.
[21]	Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome[J]. N Engl J Med, 2013, 368(23):2159-2168. doi: 10.1056/NEJMoa1214103
[22]	周英凤, 顾莺, 胡雁, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:干预性研究的质量评价(一)[J]. 护士进修杂志, 2018, 33(1):24-26.
	Zhou YF, Gu Y, Hu Y, et al. Quality assessment tool of different types of research for JBI evideuce based health care—quality evaluation of intervention study[J]. J Nurses Train, 2018, 33(1):24-26.
[23]	Chou R, Dana T, Bougatsos C, et al. Pressure ulcer risk assessment and prevention:a systematic comparative effectiveness review[J]. Ann Intern Med, 2013, 159(1):28-38. doi: 10.7326/0003-4819-159-1-201307020-00006
[24]	Walia GS, Wong AL, Lo AY, et al. Efficacy of monitoring devices in support of prevention of pressure injuries:systematic review and meta-analysis[J]. Adv Skin Wound Care, 2016, 29(12):567-574. doi: 10.1097/01.ASW.0000504579.83707.f6
[25]	Yap TL, Kennerly SM, Simmons MR, et al. Multidimensional team-based intervention using musical cues to reduce odds of facility-acquired pressure ulcers in long-term care:a paired randomized intervention study[J]. J Am Geriatr Soc, 2013, 61(9):1552-1559. doi: 10.1111/jgs.12422
[26]	Otero DP, Domínguez DV, Fernández LH, et al. Preventing facial pressure ulcers in patients under non-invasive mechani-cal ventilation:a randomised control trial[J]. J Wound Care, 2017, 26(3):128-136. doi: 10.12968/jowc.2017.26.3.128 pmid: 28277990
[27]	Lupiañez-Perez I, Uttumchandani SK, Morilla-Herrera JC, et al. Topical olive oil is not inferior to hyperoxygenated fatty aids to prevent pressure ulcers in high-risk immobilised patients in home care. Results of a multicentre randomised triple-blind controlled non-inferiority trial[J]. PLoS One, 2015, 10(4):e0122238. doi: 10.1371/journal.pone.0122238
[28]	刘晓黎, 王泠, 王志稳, 等. 无创通气设备相关面部压力性损伤预防的证据总结[J]. 中国护理管理, 2019, 19(10):1532-1537.
	Liu XL, Wang L, Wang ZW, et al. Evidence summary of prevention of noninvasive ventilation related facial pressure injuries[J]. Chin Nurs Manag, 2019, 19(10):1532-1537.