俯臥對加護病房急性呼吸窘迫症候群病人之氧合與合併症成效－系統性回顧暨統合分析

Effects of Prone Positioning on Oxygenation and Complications in Patients with Acute Respiratory Distress Syndrome (ARDS) in the Intensive Care Unit: A Systematic Review and Meta-Analysis

張惠君(Hui‐Chun Chang) ； 簡慧足(Hui‐Tsu Chien) ； 胡月娟(Yueh‐Juen Hwu)

《護理暨健康照護研究》 10卷3期 (2014/09) Pp. 178-189

https://doi.org/10.6225/JNHR.10.3.178

摘要

背景：急性呼吸窘迫症候群是加護病房常見、致死率高的疾病，俯臥是經濟且安全的照護方式，可以改善病人的氧合，增加吐氣末肺部的容積，改善肺部通氣灌流不平衡。目的：本研究運用系統性回顧，探討俯臥對改善急性呼吸窘迫症候群病人氧合及降低合併症之成效。方法：搜尋PubMed、Cochrane Library、CINAHL（Cumulative Index to Nursing and Allied Health Literature）、eMedline、ProQuest Dissertations and Themes、中文電子學位論文服務（Chinese Electronic Theses & Dissertations Service, CETD）、中文電子期刊服務資料庫（Chinese Electronic Periodical Services, CEPS）、全國博碩士論文資料庫、及臺灣期刊論文等資料庫，以設定的關鍵字進行文獻搜尋，共納入19篇研究，含9篇隨機控制實驗研究及10篇非隨機控制實驗研究。研究品質以Joanna Briggs Institute Standardised Critical Appraisal Tools做評讀，使用RevMan 5.1進行統合分析。結果：俯臥能有效改善氧合（PaO_2/FiO_2；標準平均差71.38，95%信賴區間［52.74，90.03］，p＜.00001）；合併症部份，俯臥不會影響呼吸器相關肺炎（勝算比0.91，95%信賴區間［0.45，1.85］，p=.80）與非預期氣管內管脫落（勝算比2.31，95%信賴區間［0.59，9.01］，p=.23）的發生率，但會增加壓瘡的發生（勝算比5.67，95%信賴區間［1.24，25.87］，p=.03）。結論／實務應用：為急性呼吸窘迫症候群病人執行俯臥能改善其氧合，未來運用於臨床實務中，將每一俯臥執行步驟做好，以維護病人安全，提升護理品質，降低加護病房病人的住院天數及減少醫療費用。

關鍵字

系統性回顧 ； 急性呼吸窘迫症候群 ； 俯臥 ； 氧合 ； 合併症

並列摘要

Background: Acute respiratory distress syndrome (ARDS) is a common disease in the intensive care unit with a high rate of mortality. Prone positioning is an economic and safe treatment for patients with this disease. Prone positioning improves oxygenation, increases end expiratory lung volume, improves imbalances in lung ventilation, and changes the thoracic wall mechanics in ARDS patients. Purpose: This article uses systematic review to examine the effects of prone positioning on oxygenation and complications in ARDS patients. Methods: PubMed, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), eMedline, Chinese Electronic Theses & Dissertations Service (CETD), Chinese Electronic Periodical Services (CEPS), National Digital Library of Theses and Dissertations in Taiwan, and Taiwan Periodical Literature System databasewere searched with predetermined keywords. Nineteen studies, including 9 randomized control trials (RCTs) and 10 non‐randomized control trials (non‐RCTs) that met the inclusion criteria, were included. Standardized critical appraisal tools from the Joanna Briggs Institute (JBI) were used to assess methodological quality. RevMan 5.1 software was used to conduct the meta‐analysis. Results: Prone positioning improved oxygenation, defined as the PaO_2/FiO_2 ratio (mean difference 71.38, 95% CI [52.74, 90.03], p ＜ .00001). With regard to complications, prone positioning did not influence the incidence of ventilator associated pneumonia (odds ratio [OR] 0.91, 95% CI [0.45, 1.85], p = .80) or unplanned extubation (OR = 2.31, 95% CI [0.59, 9.01], p = .23). However, prone positioning did have a significant effect on the incidence of pressure sores (OR = 5.67, 95% CI [1.24, 25.87], p = .03). Conclusions/Implications for Practice: This review supports the use of prone positioning to improve oxygenation in ARDS patients in clinical practice. Careful implementation by nursing staffs of each prone positioning procedure helps maintain patient safety, improve quality of care, decrease length of hospitalization, and reduce medical costs.

並列關鍵字

systematic review ； acute respiratory distress syndrome ； prone positioning ； oxygenation ； complications