不同口腔护理方法预防呼吸机相关性肺炎系统评价再评价

Re-evaluation of systematic evaluation on different oral nursing methods for prevention of ventilator-associated pneumonia

目的:通过系统评价再评价探讨不同口腔护理方法预防呼吸机相关性肺炎有效性的效果,为护理人员临床决策提供参考。方法:计算机检索the Cochrane Library、PubMed、中文期刊全文数据库、维普数据库、万方数据库,检索时限从建库至2017年6月30日,检索不同口腔护理方法预防呼吸机相关性肺炎的系统评价和Meta分析,采用AMSTAR工具评价纳入研究的方法学质量,采用GRADE系统对结局指标进行质量评价。结果:最终纳入11篇系统评价/Meta分析,仅3篇为高质量,10篇研究结果均显示不同于常规的口腔护理组能有效预防呼吸机相关性肺炎发生,氯己定溶液效果突出,按照GRADE系统质量评价标准对结局指标进行证据质量评价,仅3篇质量为中等,其余均为低级或极低级;鉴于存在研究的局限性,纳入的样本量较小,GRADE研究证据质量低级。结论:纳入系统评价和Meta分析的文献整体质量不高,结局指标的证据质量为中级或低级。受纳入研究的数量及质量限制,尚需更高质量的研究证实该结论的可靠性。

Objective:To explore the effectiveness of different oral nursing methods to prevent ventilator-associated pneumonia through systematic evaluation and re-evaluation,and to provide reference for clinical decision-making of nursing staff.Methods:Systematic reviews and Meta-analyses on different oral care methods for the prevention of ventilator-associated pneumonia were searched from the Cochrane Library,PubMed,CNKI,VIP,WanFang Database.The retrieval time was from inception to June 30,2017.The AMSTAR tool was used to evaluate the methodological quality of the included studies,and the GRADE system was used to evaluate the quality of outcome indicators.Results:A total of eleven systematic reviews/Meta-analyses were included,of which only three were of high quality.The results of 10 studies all showed that the oral care group was different from the conventional oral care group in effectively preventing and reducing the occurrence of hospital acquired pneumonia,and the chlorhexidine solution had a prominent effect.According to the GRADE system quality evaluation criteria,the quality of evidence was evaluated for the outcome indicators.Only 3 articles were of medium quality,and the rest were of low or very low level;in view of the limitations of the study the sample size included was small,and the quality of GRADE research evidence was low.Conclusion:The overall quality of the literature included in the systematic evaluation and Meta analysis is not high,and the quality of the evidence of the outcome indicators is intermediate or low.Limited by the number and quality of included studies,higher quality studies are needed to confirm the reliability of this conclusion.