目的 全面检索并汇总ICU成人气管插管患者围拔管期管理的最佳证据总结,为临床医护人员提供参考。方法 系统检索UpToDate、BMJ Best Practice、英国国家卫生与临床优化研究所网站、苏格兰院际指南网、国际指南协作网、美国国立指南库、加拿大安大略注册护士协会网站、美国重症医学会网站、欧洲重症医学会网站、医脉通指南网、Cochrane Library、PubMed、Embase、CINAHL、中国生物医学文献数据库、中国知网、维普网、万方数据库中有关ICU成人气管插管患者围拔管期的临床决策、指南、证据总结、系统评价及专家共识等,检索时限为建库至2023年3月,由4名研究者对符合纳入标准的文献进行质量评价及证据提取。结果 最终纳入16篇文献,其中临床决策5篇、指南10篇、系统评价1篇。包括拔管前（拔管前评估、制订计划、准备度测试）、拔管中、拔管后（密切监测、特殊人群、重新进食）3个主题、6个副主题、28条最佳证据。结论 该研究汇总的最佳证据可为医护人员高效管理拔管失败高危人群及规范围拔管期护理提供参考,临床实践中需结合具体情况,针对性地选择应用证据,以改善患者预后,提升护理质量。
Objective To search and summarize the best evidences for the management of the peri-extubation period for ICU adult patients with tracheal intubation,which will provide practical reference for clinical medical staff. Methods We systematically searched UpToDate,BMJ Best Practice,National Institute for Health and Clinical Excellence,Scottish Intercollegiate Guidelines Network,Guidelines International Network,US National Guideline Clearinghouse,Registered Nurses Association of Ontario,American Society of Intensive Care Medicine,European Society of Intensive,Medlive guide,Cochrane Library,PubMed,Embase,CINAHL,SinoMed,CNKI,VIP database,Wangfang database about Clinical decisions,guidelines,best evidences,systematic reviews,expert consensus related to the extubation period for adult patients with tracheal intubation,the retrieval period was from the date of inception to March,2023. Two reviewers independently screened the literatures and extracted data. Results 16 articles were included,with 5 clinical decisions,10 guidelines,and a systematic review. A total of 28 best evidences were collected from 6 subthemes and 3 themes,including before extubation（pre-extubation assessment,planning,readiness testing）,extubation and after extubation（monitoring,special populations,re-eating）. Conclusion The best evidences summarized in this study can provide reference for medical staff to manage patients with high-risk failure of extubation and standardize the nursing during the extubation period. In clinical practice,it is necessary to combine the best evidences with specific situations,select and apply the evidences to improve patient prognosis and nursing quality.
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