脑外伤机械通气预防呼吸机相关性肺炎的循证护理

Evidenced-based nursing for prevention of ventilator-associated pneumonia in one case of traumatic brain injury

目的预防脑外伤机械通气患者发生呼吸机相关性肺炎,调查患者插管期间口腔护理液选择、口腔护理频次、体位等最佳证据。方法运用循证护理的方法学,检索National Guidelines Clearinghouse、RNAO、BMJ、Cochrane Database of Systematic Reviews、Elsevier、JBI Database of Systematic Reviews、EBM Reviews,EMbase、CNKI(1994-2010)和万方数据库中关于预防呼吸机相关性肺炎的指南、系统评价和随机对照试验,由3名研究者对文献质量进行严格评价和总结最佳证据,对1例患者使用2%氯己定漱口液进行每天2次的口腔护理,同时将患者采取45°半卧位。结果共纳入预防呼吸机相关性肺炎4篇指南和4篇荟萃分析,该例患者在机械通气期间痰培养结果均为阴性,未发生呼吸机相关性肺炎。结论在机械通气的患者中,使用氯己定消毒液进行口腔护理和45°半卧位,可有效预防呼吸机相关性肺炎的发生。

OBJECTIVE To investigate the optimal evidence during the catheter indwelling period including the selection of oral care solution, the frequency of oral care and the body posture so as to prevent the ventilatorassociated pneumonia in the traumatic brain injury patients undergoing mechanical ventilation. METHODS The evidence-based nursing was strictly followed, the guidelines, systematic reviews, and randomized controlled trials （RCTs） for the prevention of ventilator-associated pneumonia were retrieved through National Guidelines Clearinghouse,RNAO （Nursing Best Practice Guidelines）, BMJ, Cochrane Database of Systematic Reviews, Elsevier, JBI Database of Systematic Reviews, EBM Reviews, EMbase, CNKI and Wangfang Database. The quality of RCTs was critically appraised and data were extracted by 3 reviewers independentI）; one patient used 2% chlorhexidine mouthwash for the oral care, twice per day, with 45° semirecumbent pogition undertaken. RESULTS Totally 4 articles of guidelines and 4 articles of meta-analysis about the prevention of ventilatorassociated pneumonia have been involved, and the sputum culture-was negative for the patient during the mechanical ventilation, no case of ventilator-associated pneumonia has occurred. CONCLUSION The use of chlorhexidine solution for oral care with a 45° semirecumbent position can effectively prevent the ventilatorassociated pneumonia in the patients undergoing mechanical ventilation.