[1]王法颍杨子彭泽宇王晓慧范宇莹.ICU气管插管患者非计划拔管危险因素的Meta分析[J].中国卫生质量管理,2022,29(04):062-67.[doi:10.13912/j.cnki.chqm.2022.29.4.17 ]
　WANG Faying,YANG Zi,PENG Zeyu.Risk Factors for Unplanned Extubation in ICU Patients with Endotracheal Intubation: A Meta-Analysis[J].Chinese Health Quality Management,2022,29(04):062-67.[doi:10.13912/j.cnki.chqm.2022.29.4.17 ]
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ICU气管插管患者非计划拔管危险因素的Meta分析
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《中国卫生质量管理》[ISSN:1006-7515/CN:CN 61-1283/R]

卷:
第29卷
期数:
2022年04期
页码:
062-67
栏目:
护理质量
出版日期:
2022-04-28

文章信息/Info

Title:
Risk Factors for Unplanned Extubation in ICU Patients with Endotracheal Intubation: A Meta-Analysis
作者:
王法颍杨子彭泽宇王晓慧范宇莹
哈尔滨医科大学第二临床医学院
Author(s):
WANG Faying; YANG Zi; PENG Zeyu
The Second Clinical Medical College, Harbin Medical University,
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
Keywords:
Intensive Care Unit;  Endotracheal Intubation;  Unplanned Extubation;  Risk Factors;  Meta-Analysis;  Evidence-Based Nursing
分类号:
R47
DOI:
10.13912/j.cnki.chqm.2022.29.4.17
文献标志码:
A
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。
Abstract:
ObjectiveTo identify risk factors of unplanned extubation in ICU patients with endotracheal intubation.MethodsWeb 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.ResultsA 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.

参考文献/References:

［1］伍金花，黄海星，刘智利，等.气管插管非计划拔管风险评估工具的范围综述［J］.中华护理杂志，2021,56（11）：1752-1757. ［2］Tripathi S,Nunez DJ,Katyal C,et al. Plan to have no unplanned: a collaborative, hospital-based quality-improvement project to reduce the rate of unplanned extubations in the pediatric ICU ［J］. Respiratory care, 2015, 60(8): 1105-1112. ［3］Cosentino C,Fama M,Foa C,et al.Unplanned extubations in intensive care unit: evidences for risk factors,a literature review［J］. Acta Biomed,2017,88 (5S): 55-65. ［4］周凯妃,莫新少.肝切除术后肺部感染危险因素的Meta分析［J］.中国感染控制杂志,2019,18(4):305-313. ［5］周华东,龙贤,孔德娇,等.中医药治疗PCI术后焦虑抑郁状态疗效的Meta分析［J］.中医药临床杂志,2021,33(3):455-461. ［6］Chuang ML, Lee CY, Chen YF, et al. Revisiting unplanned endotracheal extubation and disease severity in intensive care units［J］. PLoS One,2015,10 (10): e0139864. ［7］De Groot RI, Dekkers OM, Herold IH, et al. Risk factors and outcomes after unplanned extubations on the ICU: a case-control study［J］. Crit Care,2011,15(1): R19. ［8］Chang LC, Liu PF, Huang YL, et al. Risk factors associated with unplanned endotracheal self-extubation of hospitalized intubated patients: a 3-year retrospective case-control study［J］. Appl Nurs Res, 2011,24(3):188-192. ［9］Kwon E,Choi K.Case-control study on risk factors of unplanned extubation based on patient safety model in critically ill patients with mechanical ventilation［J］.Asian Nurs Res , 2017 ,11(1):74-78. ［10］Aydogan S, Kaya N. The assessment of the risk of unplanned extubation in an adult intensive care unit［J］. Dimens Crit Care Nurs, 2017,36(1):14-21. ［11］Gueret RM, Tulaimat A, Morales-Estrella JL. Self-extubation revisited: a case-control study［J］. Respiratory Care, 2020, 65(9): 1301-1308. ［12］Abbas A, Lutfy SM. Incidence, risk factors, and consequences of unplanned extubation［J］. The Egyptian Journal of Chest Diseases and Tuberculosis, 2019, 68(3): 346. ［13］邓媛丽.ICU气管插管非计划性拔管影响因素的病例对照研究［J］.中外医学研究,2017,15(16):153-154. ［14］张飞飞,陈春春,曹拂晓.ICU气管插管患者非计划性拔管的相关因素与护理对策［J］.中医药管理杂志,2018,26(11):182-184. ［15］Jarachovic M, Mason M, Kerber K, et al. The role of standardized protocols in unplanned extubations in a medical intensive care unit［J］. Am J Crit Care,2011,20(4): 304-311. ［16］Piriyapatsom A,Chittawatanarat K,Kongsayreepong S,et al. Incidence and risk factors of unplanned extubation in critically ill surgical patients: the multi-center Thai University-based Surgical Intensive Care Units Study (THAI-SICU Study)［J］.J Med Assoc Thai,2016,99 (Suppl6):S153-S162. ［17］Uy ABC, Ramos EFP, Rivera AS, et al. Incidence, risk factors, and outcomes of unplanned extubation in adult patients in a resource-limited teaching hospital in the Philippines: a cohort study［J］. Rev Bras Ter Intensiva, 2019, 31(1): 79-85. ［18］Kerber K,Zangmeister J,McNett M.Relationship between delirium and ventilatory outcomes in the medical intensive care unit ［J］. Critical Care Nurse, 2020, 40(2): 24-31. ［19］Compston A. Aids to the investigation of peripheral nerve injuries［J］. Brain, 2010, 133(10): 2838-2844. ［20］Da Silva PS, Fonseca MC. Unplanned endotracheal extubations in the intensive care unit: systematic review, critical appraisal, and evidence-based recommendations ［J］. Anesthesia and Analgesia, 2012, 114(5): 1003-1014. ［21］黎张双子,何琼,罗祎,等.ICU患者非计划性拔管危险因素的Meta分析［J］.山东医药,2017,57(16):69-71. ［22］Lee JY,Park HA,Chung E. Use of electronic critical care flow sheet data to predict unplanned extubation in ICUs［J］.International Journal of Medical Informatics,2018,117: 6-12. ［23］Lee TW, Hong JW, Yoo JW, et al. Unplanned extubation in patients with mechanical ventilation: experience in the medical Intensive Care Unit of a single tertiary hospital［J］. Tuberc Respir Dis (Seoul), 2015,78(4): 336-340. ［24］Chao CM, Sung MI, Cheng KC, et al. Prognostic factors and outcomes of unplanned extubation［J］. Sci Rep, 2017,7(1):8636. ［25］中华医学会重症医学分会.中国成人ICU镇痛和镇静治疗指南［J］.中华重症医学电子杂志(网版),2018,4(2):90-113. ［26］Ai ZP, Gao XL, Zhao XL. Factors associated with unplanned extubation in the intensive care unit for adult patients: a systematic review and meta-analysis ［J］. Intensive & Critical Care Nursing, 2018, 47:62-68. ［27］Kiekkas P, Aretha D, Panteli E, et al. Unplanned extubation in critically ill adults: clinical review［J］. Nurs Crit Care,2013,18(3):123-134. ［28］Greaves D, Psaltis PJ, Davis DHJ, et al. Risk factors for delirium and cognitive decline following coronary artery bypass grafting surgery: a systematic review and meta-analysis［J］. J Am Heart Assoc,2020,9(22):e017275. ［29］Qi Z, Yang S, Qu J, et al. Effects of nurse-led sedation protocols on mechanically ventilated intensive care adults: a systematic review and meta-analysis ［J］. Australian Critical Care, 2021, 34(3): 278-286. ［30］Cui N, Zhang Y, Liu Y, et al. Protocol for the adaptation of clinical practice guidelines for the management of physical restraints in critically ill patients［J］.Ann Palliat Med,2021,10(4):4889-4896. ［31］Tanios MA, Epstein SK, Livelo J, et al. Can we identify patients at high risk for unplanned extubation?A large-scale multidisciplinary survey［J］. Respir Care,2010,55(5):561-568. ［32］陈翔,黄春美,张园园,等.质量指标监测在ICU患者约束集束化护理管理中的应用［J］.中国卫生质量管理,2019,26(3):26-29. ［33］Burk RS，Grap MJ，Munro CL，et al. Predictors of agitation in critically ill adults ［J］. Am J Crit Care，2014，23（5）：414-423. ［34］徐燕,石卫琳,郎黎薇,等.减少ICU患者身体约束的循证护理实践［J］.中华护理杂志,2019,54(1):19-24. ［35］Hurlock-Chorostecki C, Kielb C. Knot-So-Fast: a learning plan to minimize patient restraint in critical care ［J］. Dynamics, 2006, 17(3): 12-18. ［36］马冬花, 胡文婷, 钟平, 等. 手指固定装置在拔管高风险患者中的应用［J］.护理学杂志, 2019, 34(23): 41-42,61. ［37］Curry K, Cobb S, Kutash M, et al. Characteristics associated with unplanned extubations in a surgical intensive care unit ［J］. Am J Crit Care, 2008, 17(1): 45-51. ［38］Everhart KK, Khorsand S, Khandelwal N, et al. Nighttime extubation does not increase risk of reintubation, length of stay, or mortality: experience of a large, urban, teaching hospital ［J］. Anesthesia and Analgesia, 2019, 128(5): 918-923. ［39］Su X, Wang DX. Improve postoperative sleep: what can we do［J］. Curr Opin Anaesthesiol, 2018, 31(1): 83-88. ［40］金 环, 夏家红, 杨晓霞,等. 患者安全目标：管路安全影响因素与管理策略 ［J］.中国卫生质量管理,2020, 27(6): 9-12.

更新日期/Last Update: 2022-04-28