呼吸机相关性肺炎预防的最佳证据总结

Summary of the Best Evidence for the Prevention of Ventilator-Associated Pneumonia

摘要: 目的：检索、评价并汇总国内外关于呼吸机相关性肺炎预防的最佳证据，为临床护理实践提供参考依据。方法：根据“6S”证据金字塔模型，通过计算机检索BMJ Best Practice、UpToDate、国际指南网、英国国家卫生与临床优化研究所、苏格兰学院间指南网、加拿大安大略注册护士协会、美国呼吸治疗学会、美国胸科协会、CHEST、Cochrane Library、JBI循证卫生保健中心数据库、Embase、Pubmed、医脉通、中国医学会呼吸病学分会、中国生物医学文献数据库、中国知网、万方数据库等；检索时限为2017年1月1至2022年2月23日；检索呼吸机相关性肺炎预防的证据总结、指南、系统评价等内容。经过质量评价及汇总，形成最佳证据。结果：共纳入35篇文章，其中7篇证据总结，2篇指南，26篇系统评价，最终形成35条推荐意见，包括早期筛查、手卫生、体位、口腔护理、气囊压管理、声门下吸引、减少有创通气时间、肠内营养、清洁与消毒、更换频率、器械选择、选择性消化道去污、益生菌、应激性溃疡、教育与培训15个主题。结论：本研究汇总了预防呼吸机相关性肺炎的最佳证据，为预防呼吸机相关性肺炎提供参考，实施规范化管理，以期降低呼吸机相关性肺炎的发生率，提升护理质量。

Abstract: Objective: To search, evaluate and summarize the best evidence about the prevention of ventilator-associated pneumonia at home and abroad, and to provide reference for clinical nursing practice. Methods: According to the “6S” evidence pyramid model, BMJ Best Practice, UpToDate, International Guidelines Network, National Institute for Health and Clinical Excellence, Scotland Inter-College Guidelines Network, Ontario Association of Registered Nurses, Canada, American Society of Respiratory Therapy, American CHEST Society, CHEST, Cochrane Li-brary, JBI were searched by computer Evidence-based Health Care Center Database, Embase, Pub-med, Shimai Tong, Chinese Medical Association Respiratory Branch, China Biomedical Literature Database, China National Knowledge Network, Wanfang Database, etc.; the search period was from January 1, 2017 to February 23, 2022. The evidence summary, guidelines and systematic review for the prevention of ventilator-associated pneumonia were searched. After quality evaluation and summary, form the best evidence. Results: A total of 35 articles were included, including 7 evidence summaries, 2 guidelines and 26 systematic reviews, and 35 recommendations were finally formed. There are 15 topics including early screening, hand hygiene, posture, oral care, bladder pressure management, subglottic suction, reduction of invasive ventilation time, enteral nutrition, cleaning and disinfection, frequency of replacement, instrument selection, selective digestive decontamina-tion, probiotics, stress ulcers, education and training. Conclusion: This study summarized the best evidence for the prevention of ventilator-associated pneumonia, to provide reference for the pre-vention of ventilator-associated pneumonia, to implement standardized management, in order to reduce the incidence of ventilator-associated pneumonia, improve the quality of care.