危重症患儿气管插管非计划性拔管影响因素的Meta分析

doi:10.3761/j.issn.2096-7446.2025.05.006

摘要/Abstract

摘要：

目的系统评价危重症患儿气管插管非计划性拔管的影响因素。方法计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Cochrane Library、Web of Science中关于危重症患儿气管插管非计划性拔管影响因素的队列研究、病例对照研究或横断面研究，检索时限从各数据库建库至2024年5月。由2名研究者独立筛选文献，提取资料并评价文献质量后，采用RevMan 5.3软件进行Meta分析。结果最终纳入15篇文献，其中6篇队列研究、4篇病例对照研究和5篇横断面研究，包含54 397例患儿，共发生非计划性拔管2 401例。Meta分析结果显示：年龄≤2岁（OR=1.32）、男性（OR=1.34）、体重过轻（OR=1.56）、早产儿（OR=1.63）、气道分泌物过多（OR=7.27）、镇静（OR=3.82）、躁动（OR=1.88）、机械通气时间（OR=1.03）、导管固定不当（OR=2.12）、撤机阶段（OR=2.23）、充气套囊（OR=0.47）、护患比（OR=2.66）、护士轮班类型（OR=2.85）和护士经验（OR=2.29）为危重症患儿气管插管非计划性拔管的独立预测因素。结论医护人员可根据影响因素作为参考进行动态评估，并采取针对性的预防措施，尽可能降低危重症患儿气管插管非计划性拔管的发生率。

关键词: 儿童, 危重症, 非计划性拔管, 影响因素, Meta分析, 循证护理学

Abstract:

Objective To systematically review the factors for unplanned extubation of endotracheal intubation in critically ill children. Methods CNKI，WanFang Data，VIP，SinoMed，PubMed，Embase，Cochrane Library and Web of Science databases were electronically searched to collect relevant cohort，case-control or cross-sectional studies on factors of unplanned extubation of endotracheal intubation in critically ill children from inception to May 2024. Two researchers independently screened literature，extracted data and assessed the quality of included studies. Meta-analysis was then performed by using RevMan 5.3. Results A total of 15 articles were included，involving 6 cohort studies，4 case-control studies and 5 cross-sectional studies. The studies included a total of 54 397 ill children，with a total of 2 401 unplanned extubation. The risk factors were age ≤2（OR=1.32）， male（OR=1.34）， underweight（OR=1.56）， prematurity（OR=1.63）， secretions（OR=7.27）， sedation（OR=3.82）， agitation（OR=1.88），mechanical ventilation duration（OR=1.03）， inadequate fixation（OR=2.12）， ventilator weaning phase（OR=2.23）， tube with cuff（OR=0.47）， nurse/patient ratio（OR=2.66）， work shift（OR=2.85）and nurse experience（OR=2.29）. Conclusion Medical staff can make a dynamic assessment according to the influencing factors and take targeted preventive measures to minimize the incidence of unplanned extubation of endotracheal intubation in critically ill children.

Key words: Children, Critically Ill, Unplanned Extubation, Influencing Factors, Meta-Analysis, Evidence-Based Nursing

张悦琪, 王幼芳, 潘蒙, 向璇. 危重症患儿气管插管非计划性拔管影响因素的Meta分析[J]. 中华急危重症护理杂志, 2025, 6(5): 548-554.

ZHANG Yueqi, WANG Youfang, PAN Meng, XIANG Xuan. The factors influencing unplanned endotracheal extubation in critically ill children：a meta-analysis[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(5): 548-554.

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参考文献 34

[1]	Villarroel GS, Faúndez M, Jalil YF, et al. Factors associated with accidental decannulation in tracheostomized children[J]. Respir Care, 2023, 68(2):173-179.
[2]	黄静, 马燕兰, 王晓媛, 等. 基于医院信息化背景的住院患者非计划拔管自动监测系统的研发[J]. 中国护理管理, 2021, 21(11):1716-1720.
	Huang J, Ma YL, Wang XY, et al. Development of Unplanned Extubation Monitoring System for hospitalized patients based on hospital informatization environment[J]. Chin Nurs Manag, 2021, 21(11):1716-1720.
[3]	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.
[4]	Le Blanc G, Jabbour E, Patel S, et al. Organizational risk factors and clinical impacts of unplanned extubation in the neonatal intensive care unit[J]. J Pediatr, 2022,249:14-21.e5.
[5]	Cho JE, Yeo JH. Risk factors for unplanned extubation in ventilated neonates in South Korea[J]. J Pediatr Nurs,2022,62:e54-e59.
[6]	Lucas da Silva PS, Unplanned extubation in pediatric critically ill patients:a systematic review and best practice recommendations[J]. Pediatr Crit Care Med, 2010, 11(2):287-294.
[7]	顾秋芳, 赵丽, 张春旭. 医疗失效与效应分析管理在PICU气管插管非计划性拔管中的应用[J]. 护理实践与研究, 2020, 17(1):117-119.
	Gu QF, Zhao L, Zhang CX. Application of healthcare failure mode and effect analysis management in unplanned extubation of PICU tracheal intubation[J]. Nurs Pract Res, 2020, 17(1):117-119.
[8]	Li PB, Sun ZH, Xu JY. Unplanned extubation among critically ill adults:a systematic review and meta-analysis[J]. Intensive Crit Care Nurs, 2022,70:103219.
[9]	刘云访, 喻姣花. 防范气管插管非计划性拔管的集束化护理研究进展[J]. 护理学杂志, 2019, 34(20):106-110.
	Liu YF, Yu JH. Care bundles for prevention of unplanned endotracheal extubation:a review[J]. J Nurs Sci, 2019, 34(20):106-110.
[10]	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605. doi: 10.1007/s10654-010-9491-z pmid: 20652370
[11]	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四:观察性研究的质量评价工具[J]. 中国循证心血管医学杂志, 2012, 4(4):297-299.
	Zeng XT, Liu H, Chen X, et al. Meta-analysis series IV:quality evaluation tools for observational research[J]. Chin J Evid Based Cardiovasc Med, 2012, 4(4):297-299.
[12]	Neves VC, Locatelli CGR, Ramalho O, et al. Pediatric unplanned extubation risk score:a predictive model for risk assessment[J]. Heart Lung, 2023,62:50-56.
[13]	Perry T, Klugman D, Schumacher K, et al. Unplanned extubation during pediatric cardiac intensive care:U.S. multicenter registry study of prevalence and outcomes[J]. Pediatr Crit Care Med, 2023, 24(7):551-562.
[14]	da Silva PSL, Fonseca MCM. Factors associated with unplanned extubation in children:a case-control study[J]. J Intensive Care Med, 2020, 35(1):74-81.
[15]	Hatch LD, Grubb PH, Markham MH, et al. Effect of anatomical and developmental factors on the risk of unplanned extubation in critically ill newborns[J]. Am J Perinatol, 2017, 34(12):1234-1240. doi: 10.1055/s-0037-1603341 pmid: 28494497
[16]	Kanthimathinathan HK, Durward A, Nyman A, et al. Unplanned extubation in a paediatric intensive care unit:prospective cohort study[J]. Intensive Care Med, 2015, 41(7):1299-1306. doi: 10.1007/s00134-015-3872-4 pmid: 26077068
[17]	Fitzgerald RK, Davis AT, Hanson SJ, et al. Multicenter analysis of the factors associated with unplanned extubation in the PICU[J]. Pediatr Crit Care Med, 2015, 16(7):e217-e223.
[18]	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]. Respir Care, 2015, 60(8):1105-1112. doi: 10.4187/respcare.03984 pmid: 25989811
[19]	Razavi SS, Nejad RA, Mohajerani SA, et al. Risk factors of unplanned extubation in pediatric intensive care unit[J]. Tanaffos, 2013, 12(3):11-16.
[20]	许翠花, 张玉侠, 顾莺, 等. 儿科气管插管非计划性拔管现况调查与分析[J]. 中国护理管理, 2013, 13(1):36-39.
	Xu CH, Zhang YX, Gu Y, et al. The current status of unplanned extubation in pediatric intensive care units[J]. Chin Nurs Manag, 2013, 13(1):36-39.
[21]	Carvalho FL, Mezzacappa MA, Calil R, et al. Incidence and risk factors of accidental extubation in a neonatal intensive care unit[J]. J Pediatr, 2010, 86(3):189-195.
[22]	Ream RS, MacKey K, Leet T, et al. Association of nursing workload and unplanned extubations in a pediatric intensive care unit[J]. Pediatr Crit Care Med, 2007, 8(4):366-371.
[23]	Marcin JP, Rutan E, Rapetti PM, et al. Nurse staffing and unplanned extubation in the pediatric intensive care unit[J]. Pediatr Crit Care Med, 2005, 6(3):254-257.
[24]	Cheon EC, Cheon JM, Chun Y. Risk factors and outcomes associated with unplanned intraoperative extubation of the pediatric surgical patient:an analysis of the NSQIP-P database[J]. Paediatr Anaesth, 2023, 33(9):746-753.
[25]	Sharek PJ, Horbar JD, Mason W, et al. Adverse events in the neonatal intensive care unit:development,testing,and findings of an NICU-focused trigger tool to identify harm in North American NICUs[J]. Pediatrics, 2006, 118(4):1332-1340. doi: 10.1542/peds.2006-0565 pmid: 17015521
[26]	Berkow L, Kanowitz A. Unplanned extubation:A common and costly complication of airway management[J]. Patient Safety, 2020, 2(1):22-30.
[27]	Kambestad KK, Huack A, Nair S, et al. The adverse impact of unplanned extubation in a cohort of critically ill neonates[J]. Respir Care, 2019, 64(12):1500-1507. doi: 10.4187/respcare.06721 pmid: 31138734
[28]	黄颖, 董鸿捌, 陈云娥. 右美托咪定在重症患儿镇静镇痛的有效性和安全性分析[J]. 中国医药指南, 2024, 22(7):5-9.
	Huang Y, Dong HB, Chen YE. Efficacy and safety of dexmetomidine in sedation and analgesia in critically ill children[J]. Guide Chin Med, 2024, 22(7):5-9.
[29]	Barbosa, Taís Pagliuco, Beccaria, et al. Association between sedation and adverse events in intensive care patients[J]. Acta paul,enferm, 2018,31.
[30]	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.
[31]	Ferreira JCD, Nascimento MS, Brandi S, et al. Quality improvement project to reduce unplanned extubations in a paediatric intensive care unit[J]. BMJ Open Qual, 2023, 12(1):e002060.
[32]	Minda Z, Samuel H, Aweke S, et al. Magnitude and associated factors of unplanned extubation in intensive care unit:a multi-center prospective observational study[J]. Ann Med Surg, 2022,79:103936.
[33]	方颖, 邵乐文. 美国医院流动护士管理概述及对我国多点执业护士管理的启示[J]. 中华护理教育, 2022, 19(9):857-860.
	Fang Y, Shao LW. The management of float nurse in American hospitals and its implications to the management of multiple-sites nurse practitioners in China[J]. Chin J Nurs Educ, 2022, 19(9):857-860.
[34]	Lamy Filho F, Silva AA, Lopes JM, et al. Staff workload and adverse events during mechanical ventilation in neonatal intensive care units[J]. J Pediatr, 2011, 87(6):487-492.