冠状动脉旁路移植患者术后肺部并发症预防及管理的证据总结

Summary of evidence on prevention and management of postoperative pulmonary complications in patients undergoing coronary artery bypass grafting

目的检索并获取冠状动脉旁路移植患者术后肺部并发症预防及管理的相关证据,为临床护理实践提供循证依据。方法按照“6S”证据模型检索文献,采用JBI循证卫生保健中心的文献评价标准和证据分级系统对各类研究进行文献质量评价及证据级别评定。结果共纳入19篇文献,其中3篇指南、4篇证据总结及12篇系统评价。汇总出27条相关证据,包括患者评估、术前预康复、麻醉与镇痛、口咽净化与机械通气、术后康复、患者督导及教育6个主题。结论冠状动脉旁路移植患者术后肺部并发症预防及管理的最佳证据,可为临床实践提供循证依据,在证据的应用阶段还应结合实际情况及患者意愿慎重选择。

Objective To search and obtain the evidence on prevention and management of postoperative pulmonary complications in patients undergoing coronary artery bypass grafting,so as to provide evidence-based reference for nursing practice.Methods Relevant literature was searched following the 6S pyramid model in electronic databases and websites.Quality of the literature and levels of evidence were established using the assessment tools of the Joanna Briggs Institute(JBI).Results A total of 19 publications were included,involving 3 guidelines,4 evidence summaries and 12 systematic reviews.Six aspects of 27 pieces of evidence were summarized,including patient assessment,preoperative rehabilitation,anesthesia and analgesia,oropharyngeal decontamination and ventilation,postoperative rehabilitation,patient supervision and education.Conclusion The best evidence on prevention and management for postoperative pulmonary complications in patients undergoing coronary artery bypass grafting can provide evidence-based references for clinical practice.In the phase of evidence application,the evidence should be implemented based on clinical environment and patients′preference.