老年患者吸入性肺炎防治与管理的最佳证据总结

目的:总结老年患者吸入性肺炎防治与管理的最佳证据,为临床护理工作提供依据。方法:系统检索国内外指南网、相关机构网站及数据库关于吸入性肺炎防治与管理的相关证据,包括指南、专家共识、系统评价、RCT,检索时限为2010年1月1日—2020年6月30日,语种不限。由2名研究者对纳入的文献质量进行评价,并对符合质量评价标准的文献进行证据的提取、分析和整合。结果:共纳入8篇指南、5篇专家共识、10篇系统评价和19篇RCT,进行汇总提取,形成包括11个一级指标和32个二级指标的老年患者吸入性肺炎防治与管理策略。结论:医护人员应在风险评估、体位管理、口腔管理、气道管理、用药管理、功能锻炼等方面采取有效措施以降低误吸发生风险,并加强对医护人员、老年患者及其主要照顾者的培训,通过应用最佳证据,降低老年患者误吸的发生率,从而降低吸入性肺炎的发生率。

Summary of the best evidence for the prevention and management of aspiration pneumonia in elderly patients

Objective To summarize the best evidence for the prevention and management of aspiration pneumonia in elderly patients to provide a basis for clinical nursing work.Methods We systematically searched the domestic and foreign guide nets,websites of relevant institutions and databases on the relevant evidence for the prevention and management of aspiration pneumonia,including guidelines,expert consensus,systematic reviews,randomized controlled trials(RCT),and the search time limit was from January 1,2010,to June 30,2020,and the language was not limited.Two researchers evaluated the quality of the included literature,and extracted,analyzed,and integrated evidence that met the quality evaluation criteria.Results A total of 8 guidelines,5 expert consensus,10 systematic reviews,and 19 RCTs were included.The evidence was collected and extracted to form a prevention and management strategy for elderly patients with aspiration pneumonia including 11 first-level indicators and 32 second-level indicators.Conclusions Medical and nursing staff should take effective measures in risk assessment,posture management,oral management,airway management,medication management,functional exercise and so on to reduce the risk of aspiration.Medical and nursing staff should also strengthen training for their own,elderly patients and main caregivers,and reduce the incidence of aspiration in elderly patients by applying the best evidence,so as to reduce the incidence of aspiration pneumonia.