成人气管切开相关压力性损伤预防的最佳证据总结

Summary of the best evidence for the prevention of tracheostomy-related pressure injury in adults

目的评价并总结成人气管切开相关压力性损伤(tracheostomy-related pressure injury,TRPI)预防的相关证据,为临床实践者提供决策参考。方法系统检索UpToDate、BMJ Best Practice、JBI循证卫生保健数据库、国际指南协作网、美国指南网、加拿大安大略注册护士协会、美国危重病医学会、欧洲压力性损伤咨询委员会、美国压力性损伤咨询委员会、Cochrane Library、PubMed、知网、万方等数据库中关于成人TRPI预防的临床决策、指南、推荐实践、证据总结、专家共识等证据,并由2名研究者进行质量评价和证据级别评定。结果共纳入15篇文献,包括临床决策2篇、指南8篇、证据总结2篇、推荐实践1篇、专家共识2篇,从风险评估、皮肤评估、气管套管和系带的选择与应用、预防性敷料的选择与应用、皮肤护理、营养评估与支持、组织管理与教育培训共7个方面汇总32条证据。结论临床机构和医护人员应评估就医环境、耗材成本、患者意愿等因素,结合相关级别的循证依据,规范化实施预防策略,减少TRPI发生。

Objective To evaluate and summarize the relevant evidence of the prevention of tracheostomy-related pressure injury(TRPI)in adults,and to provide references for clinical practice.Methods We searched for clinical decisions,guidelines,recommended practices,evidence summaries,expert consensuses and other evidence on the prevention of TRPI in the UpToDate,BMJ Best Practice,Joanna Briggs Institute Library,Guidelines International Network,National Guideline Clearinghouse,Registered Nurses’Association of Ontario,Society of Critical Care Medicine,European Pressure Ulcer Advisory Panel,National Pressure Injury Advisory Panel,Cochrane Library,PubMed,CNKI,Wanfang Data etc.Results A total of 15 articles were incorporated,including 2 clinical decisions,8 guidelines,2 evidence summaries,1 recommended practice,2 expert consensuses.Thirty-two pieces of the best evidence were summarized in 7 aspects,namely risk assessment,skin assessment,selection and application of tracheal cannula and tapes,selection and application of preventive dressings,skin care,nutrition assessment and support,organization management and education training.Conclusion Clinical institutions and medical staffs should evaluate factors such as the medical environment,cost of consumables,and patients’willingness,and combine with the best evidence to implement preventive strategies in a standardized manner,and ultimately reduce the occurrence of TRPI.