重症患者膈肌功能障碍评估的范围综述

Critical illness-related diaphragmatic dysfunction assessment:a scoping review

目的对国内外重症患者膈肌功能障碍的相关研究进行范围综述,了解危重症相关膈肌功能障碍评估的研究现状,为护士在ICU中对患者实施膈肌功能障碍评估,促进早期肺康复提供参考。方法根据澳大利亚乔安娜布里格斯研究所范围综述指南,计算机检索PubMed、Embase、Web of Science、中国知网、万方数据库中的相关研究。检索时限为建库至2022年9月4日。对纳入文献进行分析。结果最终纳入39篇文献,其中2篇为回顾性队列研究、37篇为前瞻性研究。膈肌功能障碍的概念范围包含膈肌膨隆、膈肌无力和膈肌麻痹。评估方法有膈肌超声、双侧膈神经刺激检查。评估指标主要包括膈肌增厚分数、膈肌移动度、反常膈肌运动及由膈神经刺激引起的气管内压力。结论国内护理研究者应重视重症患者膈肌功能障碍相关的问题及并发症,并选择规范统一的评估方式,采用多种指标综合评估患者的膈肌功能,进而评估患者的肺功能,以便进行更精准的护理干预,促进患者早期康复。

Objective A scoping review of studies on critical diaphragmatic dysfunction at home and abroad was conducted to grasp the current state of research in the topic.Methods In accordance with the scope review’s research methodologies,databases including PubMed,Embase,Web of Science,CNKI,and Wan fang were searched by the computer for relevant studies.The deadline for retrieval is from the establishment of databases to September 4,2022.There was an analysis of the included literature.Results 39 articles were finally included.Two of them were historical cohort studies,while the other 37 were prospective ones.The conceptual spectrum of diaphragm dysfunction includes eventration,frailty,and paralysis of the diaphragm.The evaluation procedures included ultrasound of the diaphragm and bilateral phrenic nerve stimulation.Diaphragm thickness fraction,diaphragm movement,abnormal diaphragm movement,and endotracheal pressure induced by phrenic nerve stimulation are the primary evaluation indicators.Conclusion Domestic nursing researchers should focus on the problems and complications associated with diaphragmatic dysfunction in severely ill patients,select a standardized and unified evaluation method,and use a variety of indicators to comprehensively evaluate the diaphragm function of patients in order to better treat patients and aid in their early recovery.