机械通气患者床旁纤维支气管镜检查术操作配合的最佳证据总结

doi:10.3761/j.issn.2096-7446.2025.11.014

摘要/Abstract

摘要：

目的检索、评价和整合机械通气患者床旁纤维支气管镜检查术操作配合的相关证据。方法计算机检索国内外数据库、相关专业网站中关于机械通气患者床旁纤维支气管镜检查术护理配合的决策支持系统、综合性证据总结、循证指南、专家共识、系统评价、原始研究，文献检索时限为2014年12月31日—2024年12月31日，由2名研究者独立进行文献质量评价后，根据主题对证据进行提取与汇总。结果根据纳入标准，共筛选出11篇文献，包括5篇综合性证据总结、3篇指南、3篇专家共识。通过文献阅读、证据提取和归类，从适应证、风险评估、患者准备、用物准备、操作人员管理、呼吸道管理、镇静镇痛管理、并发症识别与管理、检查后评估、感控管理、设备处理11个主题总结出33条证据。结论该研究总结了机械通气患者床旁纤维支气管镜检查术操作配合的最佳证据，可为护理人员开展临床实践提供参考。护理人员应结合临床情境审慎地选择并应用证据，从而保障患者安全，降低相关并发症的发生率。

关键词: 纤维支气管镜, 机械通气, 操作配合, 麻醉护理, 证据总结

Abstract:

Objective To retrieve，evaluate，and integrate evidence for the cooperation of bedside fiberoptic bronchoscopy in mechanically ventilated patients. Methods The decision support system，synthesized evidence summaries，guidelines，systematic review and studies on nursing cooperation with bedside fiberoptic bronchoscopy for patients with mechanical ventilation were searched by computer in domestic and foreign databases and related professional websites. The literature search period was from December 31，2014 to December 31，2024. The literature quality was independently evaluated by 2 researchers. The evidences were extracted and summarized according to the topic. Results According to the inclusion criteria，a total of 11 literatures were selected，including 5 synthesized evidence summaries，3 guidelines and 3 expert consensuses. Through literature reading，evidence extraction and classification，33 pieces of evidence were summarized from 11 topics，including indications，risk assessment，patient preparation，substance preparation，operator management，respiratory management，sedation and analgesia management，complication identification and management，post-examination assessment，infection control management，equipment handling. Conclusion This study summarizes the best evidence for the cooperation of bedside fiberoptic bronchoscopy in mechanically ventilated patients，which can provide reference for nurses to carry out clinical practice. Nursing staff should carefully select and apply evidence in the context of the clinical situation to ensure patient safety and reduce the incidence of related complications.

Key words: Fiberoptic Bronchoscope, Mechanical Ventilation, Operational Cooperation, Anesthesia Nursing, Evidence Summary

丁敏玲, 张偌翠, 张转运, 王晴, 侯敏, 顾金甜, 李雪云, 顾小萍. 机械通气患者床旁纤维支气管镜检查术操作配合的最佳证据总结[J]. 中华急危重症护理杂志, 2025, 6(11): 1362-1369.

DING Minling, ZHANG Ruocui, ZHANG Zhuanyun, WANG Qing, HOU Min, GU Jintian, LI Xueyun, GU Xiaoping. Evidence summary for cooperation of bedside fiberoptic bronchoscopy in mechanically ventilated patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(11): 1362-1369.

图/表 6

图1

图2

表1

表2

表3

表4

参考文献 26

[1]	周越, 张杰, 潘宇帆, 等. 机械通气患者衰弱风险预测模型的系统评价[J]. 护理学报, 2024, 31(6):56-61. doi: 10.16460/j.issn1008-9969.2024.06.056
	Zhou Y, Zhang J, Pan YF, et al. Prediction models for risk of acquired weakness in mechanically ventilated patients:a systematic review[J]. J Nurs China, 2024, 31(6):56-61.
[2]	吉莉, 吴慧, 景晨阳, 等. ICU患者呼吸机相关性膈肌功能障碍管理的证据总结[J]. 中华急危重症护理杂志, 2025, 6(1):100-106. doi: 10.3761/j.issn.2096-7446.2025.01.017
	Ji L, Wu H, Jing CY, et al. Summary of evidence on the management of ventilator-induced diaphragmatic dysfunction in ICU patients[J]. Chin J Emerg Crit Care Nurs, 2025, 6(1):100-106.
[3]	Zhao YQ, Dai XM, Ji JZ, et al. Bronchial lavage under fibero-ptic bronchoscopy in the treatment of severe pulmonary infe-ction[J]. Pak J Med Sci, 2020, 36(3):396-401.
[4]	蔡志刚, 张树森. 2019版《成人诊断性可弯曲支气管镜检查术应用指南》更新要点解读[J]. 河北医科大学学报, 2020, 41(11):1241-1244,1250.
	Cai ZG, Zhang SS. Explanation of the updated key points of the 2019 edition of the guidelines for the application of dia-gnostic flexible bronchoscopy in adults[J]. J Hebei Med Univ, 2020, 41(11):1241-1244,1250.
[5]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. Composition of different types of evidence-based problems[J]. J Nurse Train, 2017, 32(21):1991-1994.
[6]	邢唯杰, 周英凤, 朱政, 等. 证据金字塔的发展:从“6S”模型到“5S”模型[J]. 护士进修杂志, 2025, 40(13):1345-1348.
	Xing WJ, Zhou YF, Zhu Z, et al. The development of evidence pyramid:from “6S” model to “5S” model[J]. J Nurses Train, 2025, 40(13):1345-1348.
[7]	Foster MJ, Shurtz S. Making the critical appraisal for summa-ries of evidence(CASE) for evidence-based medicine(EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc, 2013, 101(3):192-198. doi: 10.3163/1536-5050.101.3.008
[8]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People's Medical Publishing House, 2018.
[9]	Islam S. Flexible bronchoscopy in adults:overview[EB/OL].(2024-06-14)[2024-08-20]. https://sso.uptodate.com/contents/fle-xible-bronchoscopy-in-adults-overview.
[10]	Islam S. Flexible bronchoscopy in adults:indications and con-traindications[EB/OL].(2024-05-29)[2024-08-20]. https://sso.uptodate.com/contents/flexible-bronchoscopy-in-adults-indications-and-contraindications.
[11]	Islam S. Flexible bronchoscopy in adults:preparation,procedu-ral technique,and complications[EB/OL].(2024-03-14)[2024-08-20]. https://sso.uptodate.com/contents/flexible-bronchoscopy-in-adults-preparation-procedural-technique-and-complications.
[12]	Alfille PH. Anesthesia for adult bronchoscopy[EB/OL].(2024-03-25)[2024-08-20]. https://sso.uptodate.com/contents/anesthe-sia-for-adult-bronchoscopy.
[13]	邵红艳, 孙洁, 许丽, 等. 纤维支气管镜检查患者围术期饮食管理最佳证据总结[J]. 齐鲁护理杂志, 2022, 28(22):122-125.
	Shao HY, Sun J, Xu L, et al. Summary of the best evidence of perioperative diet management for patients undergoing fibe-roptic bronchoscopy[J]. J Qilu Nurs, 2022, 28(22):122-125.
[14]	Wahidi MM, Shojaee S, Lamb CR, et al. The use of bronchos-copy during the coronavirus disease 2019 pandemic:chest/AABIP guideline and expert panel report[J]. Chest, 2020, 158(3):1268-1281. doi: S0012-3692(20)30850-3 pmid: 32361152
[15]	Mohan A, Madan KR, Hadda V, et al. Guidelines for diagnos-tic flexible bronchoscopy in adults:Joint Indian Chest Socie-ty/National College of Chest Physicians(I)/Indian Association for Bronchology Recommendations[J]. Lung India, 2019, 36(Sup-plement):S37-S89.
[16]	中华医学会呼吸病学分会介入呼吸病学学组. 成人诊断性可弯曲支气管镜检查术应用指南(2019年版)[J]. 中华结核和呼吸杂志, 2019, 42(8):573-590.
	Interventional Pulmonology Group of Respiratory Disease Branch of Chinese Medical Association. Guideline for diagnos-tic flexible bronchoscopy in adults(2019)[J]. Chin J Tubercul Resp Diseas, 2019, 42(8):573-590.
[17]	邓小明, 王月兰, 冯艺, 等. (支)气管镜诊疗镇静/麻醉专家共识(2020版)[J]. 国际麻醉学与复苏杂志, 2021, 42(8):785-794.
	Deng XM, Wang YL, Feng Y, et al. Expert consensus on seda-tion and anesthesia for bronchoscopy(2020 version)[J]. Intern J Anesthes Resusc, 2021, 42(8):785-794.
[18]	支气管镜在急危重症临床应用专家共识组. 支气管镜在急危重症临床应用的专家共识[J]. 中华急诊医学杂志, 2016, 25(5):568-572.
	Expert Group of the Clinical Application of Bronchoscopy in Emergency Medicine and Intensive Care Medicine. Expert consensus on the clinical application of bronchoscopy in emergency medicine and intensive care medicine[J]. Chin J Emerg Mede, 2016, 25(5):568-572.
[19]	中华医学会呼吸病学分会. 支气管镜诊疗操作相关大出血的预防和救治专家共识[J]. 中华结核和呼吸杂志, 2016, 39(8):588-591.
	Respiratory Disease Branch of Chinese Medical Association. Expert consensus on the prevention and treatment of massive hemorrhage related to bronchoscopy[J]. Chin J Tuber Respir Dis, 2016, 39(8):588-591.
[20]	Facciolongo N, Patelli M, Gasparini S, et al. Incidence of com-plications in bronchoscopy. Multicentre prospective study of 20,986 bronchoscopies[J]. Monaldi Arch Chest Dis, 2009, 71(1):8-14.
[21]	Stolz D, Pollak V, Chhajed PN, et al. A randomized,placebo-controlled trial of bronchodilators for bronchoscopy in patients with COPD[J]. Chest, 2007, 131(3):765-772. doi: 10.1378/chest.06-2308
[22]	Mohan A, Momin I, Poulose R, et al. Lack of efficacy of pre bronchoscopy inhaled salbutamol on symptoms and lung fun-ctions in patients with pre-existing airway obstruction[J]. Lung India, 2016, 33(4):362-366. doi: 10.4103/0970-2113.184866
[23]	Du Rand IA, Blaikley J, Booton R, et al. British Thoracic So-ciety guideline for diagnostic flexible bronchoscopy in adults:accredited by NICE[J]. Thorax, 2013, 68(Suppl 1):i1-i44.
[24]	Greenstein YY, Shakespeare E, Doelken P, et al. Defining a ven-tilation strategy for flexible bronchoscopy on mechanically ventilated patients in the medical intensive care unit[J]. J Bron-chology Interv Pulmonol, 2017, 24(3):206-210.
[25]	徐燕, 孟玫, 李磊, 等. 重症新型冠状病毒肺炎患者支气管镜操作流程推荐意见[J]. 中华重症医学电子杂志(网络版), 2020, 6(2):173-177.
	Xu Y, Meng M, Li L, et al. Recommendation on bronchoscopic procedure for patients with severe COVID-19[J]. Chin J Crit Care Intensive Care Med(Electron Ed), 2020, 6(2):173-177.
[26]	姚欢, 方金燕, 傅蓉, 等. 机械通气患者误吸预防的循证实践研究[J]. 中华急危重症护理杂志, 2023, 4(9):785-791.
	Yao H, Fang JY, Fu R, et al. Application of best evidence for aspiration prevention in patients with mechanical ventilation[J]. Chin J Emerg Crit Care Nurs, 2023, 4(9):785-791.