气管切开患者经口进食管理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2026.04.019

摘要/Abstract

摘要：

目的总结气管切开患者经口进食管理的相关证据，为临床提供实践依据。方法系统检索指南网站、专业协会网站及国内外数据库中关于气管切开患者经口进食管理的相关证据，检索时限为2015年1月1日至2025年1月31日。纳入证据类型包括临床决策、指南、证据总结、最佳实践、推荐意见、声明、专家共识、系统评价、Meta分析。由2名研究者独立进行文献质量评价、证据提取和整合。结果纳入文献13篇，包括2篇指南、5篇专家共识、1篇推荐意见、2篇证据总结和3篇系统评价。从管理组织、吞咽评估、吞咽治疗与训练、进食前的准备、进食指导、进食后的管理及并发症预防与处理7个维度归纳了22条证据。结论该研究总结了气管切开患者经口进食管理的最佳证据，具有一定的科学性与全面性，可为临床实践提供参考依据。

关键词: 气管切开, 经口进食, 证据总结, 循证护理学

Abstract:

Objective To summarize the best evidence on oral feeding management in tracheostomy patients and provide a reference for clinical practice. Methods Systematic searches were conducted in guideline databases，professional association websites，and domestic and international literature databases for evidence related to oral feeding management in tracheostomy patients，with a time frame from January 1，2015，to January 31，2025. Included evidence types comprised clinical decisions，guidelines，evidence summaries，best practices，recommendation，statement，expert consensuses，systematic reviews，and meta-analyses. Two researchers independently evaluated literature quality，extracted data，and synthesized evidence. Results A total of 13 articles were included，consisting of 2 guidelines，5 expert consensuses，1 recommendation ，2 evidence summaries，and 3 systematic reviews. A total of 22 pieces of evidence were synthesized across 7 dimensions：management organization，swallowing assessment，swallowing therapy and training，pre-feeding preparation，feeding guidance，post-feeding management，and complication prevention and management. Conclusion This study summarizes the best evidence for oral feeding management in tracheostomy patients，demonstrating scientific rigor and comprehensiveness. It provides a valuable reference for clinical practice.

Key words: Tracheostomy, Oral Feeding, Evidence Summary, Evidence-Based Nursing

龚立超, 梅爱英, 曹闻亚, 孙蕊, 李翠景, 常红. 气管切开患者经口进食管理的最佳证据总结[J]. 中华急危重症护理杂志, 2026, 7(4): 496-502.

GONG Lichao, MEI Aiying, CAO Wenya, SUN Rui, LI Cuijing, CHANG Hong. Best evidence summary for oral feeding management in tracheostomy patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(4): 496-502.

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参考文献 29

[1]	Intensive Care Society. Guidance for:tracheostomy care[EB/OL].(2020-08)[2025-05-06]. http://www.ics.ac.uk/Society/Guidance/PDFs/Tracheostomy_care_guidance.
[2]	赵海平, 王荣荣. 神经重症气管切开患者气道功能康复与管理专家共识(2024)[J]. 中国康复理论与实践, 2024, 30(8):869-881. doi: 10.3969/j.issn.1006-9771.2024.08.001
	Zhao HP, Wang RR. Expert consensus on rehabilitation and management of airway function for neurocritical patients with tracheotomy(2024)[J]. Chin J Rehabil Theory Pract, 2024, 30(8):869-881.
[3]	中国医学装备协会呼吸病学装备专业委员会, 中国残疾人康复协会肺康复专业委员会中青年肺康复专业学组, 中国康复医学会危重症康复学组. 气管切开患者的管理和康复治疗推荐意见[J]. 中华结核和呼吸杂志, 2023, 46(10):965-976.
	Respiratory Equipment Committee of China Association of Medical Equipment,Young and Middle-aged Pulmonary Reha-bilitation Committee of Pulmonary Rehabilitation Committee of China Association of Rehabilitation of Disabled Persons,Critical Illness Rehabilitation Group of China Association of Rehabilitation Medicine. Recommendations for the management and rehabilitation of patients with a tracheostomy[J]. Chin J Tu-bere Respir Dis, 2023, 46(10):965-976.
[4]	Mahon AM, Griffin S, Gorman E, et al. Patient-centred outcomes following tracheostomy in critical care[J]. J Intensive Care Med, 2023, 38(8):727-736. doi: 10.1177/08850666231160669
[5]	Spronk PE, Spronk LEJ, Egerod I, et al. Dysphagia in intensive care evaluation (DICE):an international cross-sectional survey[J]. Dysphagia, 2022, 37(6):1451-1460. doi: 10.1007/s00455-021-10389-y
[6]	高雨虹. 持续声门下吸引在创伤性脑损伤气管切开患者早期经口进食中的应用[J]. 医学食疗与健康, 2021, 19(28):61,63.
	Gao YH. Application of continuous subglottic aspiration in early oral feeding in patients with tracheotomy due to trau-matic brain injury[J]. Med Diet Health, 2021, 19(28):61,63.
[7]	盛施, 廖维靖, 蔺俊斌, 等. 1例ICF理论下重症脑血管病后气管切开伴吞咽障碍的康复实践[J]. 中国康复, 2023, 38(8):494-497.
	Sheng S, Liao WJ, Lin JB, et al. Rehabilitation practice of tra-cheotomy with dysphagia after severe cerebrovascular disease under ICF theory[J]. Chin J Rehabil, 2023, 38(8):494-497.
[8]	Dziewas R, Allescher HD, Aroyo I, et al. Diagnosis and treat-ment of neurogenic dysphagia-S1 guideline of the German Society of Neurology[J]. Neurol Res Pract, 2021, 3(1):23. doi: 10.1186/s42466-021-00122-3
[9]	Likar R, Aroyo I, Bangert K, et al. Management of swallowing disorders in ICU patients-A multinational expert opinion[J]. J Crit Care, 2024, 79:154447. doi: 10.1016/j.jcrc.2023.154447
[10]	Alper BS, Brian Haynes R. EBHC pyramid 5.0 for accessing preappraised evidence and guidance[J]. Evid Based Med, 2016, 21(4):123-125. doi: 10.1136/ebmed-2016-110447 pmid: 27325531
[11]	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.
[12]	Foster MJ, Shurtz S. Making the critical appraisal for sum-maries 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
[13]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[14]	Morris K, Taylor NF, Freeman-Sanderson A. Safety-related out-comes for patients with a tracheostomy and the use of flexible endoscopic evaluation of swallowing(FEES) for asse-ssment and management of swallowing:a systematic review[J]. Int J Speech Lang Pathol, 2025, 27(1):70-80. doi: 10.1080/17549507.2023.2293633
[15]	Eskildsen SJ, Wessel I, Poulsen I, et al. Rehabilitative interven-tion for successful decannulation in adult patients with acquired brain injury and tracheostomy:a systematic review[J]. Disabil Rehabil, 2024, 46(12):2464-2476. doi: 10.1080/09638288.2023.2233437
[16]	Mills CS, Michou E, King N, et al. Evidence for above cuff vocalization in patients with a tracheostomy:a systematic review[J]. Laryngoscope, 2022, 132(3):600-611. doi: 10.1002/lary.v132.3
[17]	刘玉琪, 尤德源, 徐亮. 广泛慢性危重症患者出院管理临床实践专家共识(2024版)[J]. 中国实用内科杂志, 2024, 44(9):705-729.
	Liu YQ, You DY, Xu L. Expert consensus on clinical practice of discharge management of patients with extensive chronic critical illness(2024 edition)[J]. Chin J Pract Intern Med, 2024, 44(9):705-729.
[18]	《成人气管切开拔管中国专家共识》编写组, 中华医学会物理医学与康复学分会心肺康复学组, 中国康复医学会重症康复专业委员会. 成人气管切开拔管中国专家共识(上)[J]. 中华物理医学与康复杂志, 2023, 45(6):481-487.
	The Writing Group of Chinese Expert Consensus on Tracheo-tomy Removal in Adults,the Cardiopulmonary Rehabilitation Group of the Physical Medicine and Rehabilitation Branch of the Chinese Medical Association,the Critical Care Rehabi-litation Committee of the Chinese Rehabilitation Medical Association. Chinese expert consensus on tracheotomy removal in adults(part 1)[J]. Chin J Phys Med Rehabil, 2023, 45(6):481-487.
[19]	《成人气管切开拔管中国专家共识》编写组, 中华医学会物理医学与康复学分会心肺康复学组, 中国康复医学会重症康复专业委员会. 成人气管切开拔管中国专家共识(下)[J]. 中华物理医学与康复杂志, 2023, 45(7):577-584.
	The Writing Group of Chinese Expert Consensus on Tracheo-tomy Removal in Adult,the Cardiopulmonary Rehabilitation Group of the Physical Medicine and Rehabilitation Branch of the Chinese Medical Association,the Critical Care Rehabili-tation Committee of the Chinese Rehabilitation Medical Asso-ciation. Chinese expert consensus on tracheotomy removal in adults(part 2)[J]. Chin J Phys Med Rehabil, 2023, 45(7):577-584.
[20]	胡银, 青晨, 袁梅, 等. 神经外科气管切开患者拔管指征的最佳证据总结[J]. 中华现代护理杂志, 2023, 29(21):2847-2854.
	Hu Y, Qing C, Yuan M, et al. Best evidence summary of indications for extubation in neurosurgical tracheotomy patients[J]. Chin J Mod Nurs, 2023, 29(21):2847-2854.
[21]	邓伟, 闫静, 吴伶慧, 等. ICU人工气道患者气囊周围微误吸预防及护理的证据总结[J]. 中华护理教育, 2023, 20(7):870-877.
	Deng W, Yan J, Wu LH, et al. Evidence summary for the prevention and management of microaspiration around the cuff in adult ICU patients with artificial airway[J]. Chin J Nurs Educ, 2023, 20(7):870-877.
[22]	中国吞咽障碍康复评估与治疗专家共识组. 中国吞咽障碍评估与治疗专家共识(2017年版):第二部分治疗与康复管理篇[J]. 中华物理医学与康复杂志, 2018, 40(1):1-10.
	Chinese Expert Consensus Group for Rehabilitation Assess-ment and Treatment of Dysphagia. Chinese expert consensus on assessment and treatment of dysphagia(2017 Edition)-Part Ⅱ:treatment and rehabilitation management[J]. Chin J Phys Med Rehabil, 2018, 40(1):1-10.
[23]	Osorio B, Krakora R, Epping G, et al. Aspiration after critical illness:role of endotracheal tube,tracheostomy,and swallowing disorders[J]. Semin Respir Crit Care Med, 2024, 45(6):669-677. doi: 10.1055/a-2445-9054
[24]	Mah JW, Staff Ⅱ, Fisher SR, et al. Improving decannulation and swallowing function:a comprehensive,multidisciplinary approach to post-tracheostomy care[J]. Respir Care, 2017, 62(2):137-143. doi: 10.4187/respcare.04878
[25]	Mancopes R, Smaoui S, Steele CM. Effects of expiratory mus-cle strength training on videofluoroscopic measures of swa-llowing:a systematic review[J]. Am J Speech Lang Pathol, 2020, 29(1):335-356. doi: 10.1044/2019_AJSLP-19-00107 pmid: 31999193
[26]	Speyer R, Cordier R, Sutt AL, et al. Behavioural interventions in people with oropharyngeal dysphagia:a systematic review and meta-analysis of randomised clinical trials[J]. J Clin Med, 2022, 11(3):685. doi: 10.3390/jcm11030685
[27]	Wallace S, McGowan S, Sutt AL. Benefits and options for voice restoration in mechanically ventilated intensive care unit patients with a tracheostomy[J]. J Intensive Care Soc, 2023, 24(1):104-111. doi: 10.1177/17511437221113162
[28]	Cichero JAY, Lam P, Steele CM, et al. Development of inter-national terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management:the IDDSI framework[J]. Dysphagia, 2017, 32(2):293-314. doi: 10.1007/s00455-016-9758-y pmid: 27913916
[29]	Price R, MacLennan G, Glen J, et al. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care:systematic review and network meta-analysis[J]. BMJ, 2014, 348:g2197. doi: 10.1136/bmj.g2197