ICU气管插管患者非计划拔管危险因素的Meta分析
发布人：yaot 发布时间：2022/5/10 17:18:27 浏览次数：1095次
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】?午3:45:10——王法颍 杨子 彭泽宇 王晓慧 范宇莹
【摘要】目的 明确ICU气管插管患者非计划拔管的危险因素。方法 检索Web of Science、Embase、PubMed、中国知网、中国生物医学文献数据库、万方和维普等数据库2010年1月1日-2020年12月31日有关ICU气管插管非计划拔管危险因素的队列研究或病例对照研究，由两名研究人员独立进行文献筛选、资料提取以及文献质量评价。使用RevMan 5.3统计软件对纳入文献进行Meta分析。结果 共纳入文献12篇,样本量为5 372例。Meta分析结果显示，年龄较小(WMD=-6.37)、男性(OR= 2.21)、镇静不足(OR=4.54)、RASS评分>-2分(OR=10.37)、Ramsay评级一二级(WMD=-1.05)、未使用身体约束(OR=5.35)、夜班(OR=3.31)、患有呼吸系统疾病和充血性心力衰竭(OR=2.34)、谵妄(OR=7.19)、更高的GCS评分(WMD=1.42)、心率过快（＞100次/分）(SMD=0.45)和机械通气时长(WMD=-2.31)等是ICU气管插管患者非计划拔管危险因素。结论 通过Meta分析结果，可以构建ICU气管插管患者UEE风险预测模型，对患者进行危险因素分级，识别并管理高危患者，从而科学管理管路。
【关键词】重症医学病房；气管插管；非计划拔管；危险因素；Meta分析；循证护理
中图分类号：R47文献标识码：A
Risk Factors for Unplanned Extubation in ICU Patients with Endotracheal Intubation: A Meta-Analysis/WANG Faying,YANG Zi,PENG Zeyu,et al.//Chinese Health Quality Management，2022,29(4):62-67
Abstract Objective To identify risk factors of unplanned extubation in ICU patients with endotracheal intubation.Methods Web of Science, Embase, PubMed, CNKI, CBM,Wanfang VIP Data Knowledge Service Platform from January 1, 2010 to December 31, 2020 were searched. Case control and cohort studies on risk factors for unplanned extubation in ICU patients with endotracheal intubation were retrieved from the database. Literature screening, data extraction and quality evaluation were independently conducted by two researchers, and RevMan 5.3 software was used for Meta-analysis.Results A total of 12 literatures were included (5 372 ICU patients). The statistically significant risk factors were younger age (WMD= -6.37),male (OR=2.21),inadequate sedation (OR=4.54), RASS score > -2 (OR=10.37),Ramsay score 1 or 2 categories (WMD= -1.05),non-use of physical restraint (OR=5.35),night shift (OR=3.31),suffering from respiratory disease and congestive heart failure (OR=2.34),delirium (OR=7.19), higher GCS score (WMD=1.42),heart rate too fast (>100 beats/min) (SMD=0.45) and length of mechanical ventilation (WMD= -2.31).Conclusion Through the results of Meta-analysis, a UEE risk prediction model can be established for ICU patients with tracheal intubation, which can classify patients with risk factors, identify and manage high-risk patients, and manage the pipeline scientifically.
Key words Intensive Care Unit; Endotracheal Intubation; Unplanned Extubation; Risk Factors; Meta-Analysis; Evidence-Based Nursing
Firstauthor's address The Second Clinical Medical College, Harbin Medical University, Harbin,Heilongjiang,150086, China
ICU气管插管非计划拔管(Unplanned Endotracheal Extubation, UEE)是指患者在ICU接受治疗期间，气管插管在非计划时间内脱落,包括患者无意或故意自行拔管、医护人员实施医疗操作时误拔管以及非人为因素导致的拔管［1］,其中自主拔管约占非计划拔管的68% ~ 95%［2］。一旦发生非计划拔管,可能导致患者二次插管，并发呼吸机相关肺炎等，从而延长患者住院时间，增加死亡风险［3］。非计划拔管发生率是评估ICU护理质量和安全的指标之一。本研究通过Meta分析,探索ICU气管插管患者发生非计划拔管的危险因素,以期为护理人员早识别、早干预非计划拔管提供循证依据。
