《中国康复理论与实践》

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (6): 666-673.doi: 10.3969/j.issn.1006-9771.2025.06.007

• 循证研究 • 上一篇    下一篇

成年气管切开患者拔管的直接策略与堵管策略对比的系统综述

顾逸青1,2, 程舒芃1,2, 李勇强1,2, 毛二莉2, 励建安1,2()   

  1. 1.南京医科大学康复医学院，江苏南京市 210003
    2.南京医科大学第一附属医院，江苏南京市 210003
  • 收稿日期:2025-02-26 修回日期:2025-04-23 出版日期:2025-06-25 发布日期:2025-06-16
  • 通讯作者: 励建安，E-mail： lijianan@carm.org.cn E-mail:lijianan@carm.org.cn
  • 作者简介:顾逸青(1998-)，女，汉族，江苏南通市人，硕士研究生，主要研究方向：康复医学(重症康复、神经康复)。

Capping versus non-capping decannulation strategy in adult tracheostomized patients: a systematic review

GU Yiqing1,2, CHENG Shupeng1,2, LI Yongqiang1,2, MAO Erli2, LI Jian'an1,2()   

  1. 1. School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu 210003, China
    2. The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210003, China
  • Received:2025-02-26 Revised:2025-04-23 Published:2025-06-25 Online:2025-06-16
  • Contact: E-mail: lijianan@carm.org.cn E-mail:lijianan@carm.org.cn

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摘要：

目的 系统评价成年气管切开患者直接拔管策略与堵管策略的优劣。

方法 构建PICO，检索PubMed、EMbase、Cochrane Liberary、中国知网、万方数据库和中国生物医学文献数据库中有关气管切开后的成年患者拔管措施的文献，检索时限为建库至2025年2月1日。直接拔管组在通过拔管评估后直接拔管，而不包含≥ 24 h堵管；堵管组拔管前实施≥ 24 h堵管，研究类型为随机对照试验(RCT)、队列研究、病例对照研究。采用纽卡斯尔-渥太华量表(NOS)及Cochrane偏倚风险评估量表评估文献质量。采用GRADE对结局指标进行证据质量评价。提取相关信息进行系统综述。

结果 最终纳入6篇文献，发表时间集中于2003年至2020年，来自西班牙、中国、尼泊尔和以色列4个国家，总样本量745例。非RCT研究的NOS评分为6~8分，RCT的Cochrane偏倚风险评估1篇较低，1篇中等。堵管策略包括完全堵管24~48 h后拔管、逐步缩小管径再堵管后拔管、逐步堵管后拔管；直接拔管策略包括通过拔管评估后直接拔管、内镜检查评估通过后直接拔管。与堵管策略对比，直接拔管策略可显著减少拔管时间，有更低的不良反应发生率，两种策略在拔管成功率、肺部感染发生率上无明显差异。在肺部感染和不良反应发生率上，各项研究间结论不一致。GRADE评价拔管成功率和拔管时间为低质量证据，肺部感染和不良反应发生率为极低质量证据。

结论 成年气管切开患者中，直接拔管策略比堵管策略更优，直接拔管策略能缩短拔管时间，减少不良反应，而两种策略在拔管成功率和肺部感染发生率上无明显差异。

关键词: 气管切开拔管, 重症康复, 堵管, 系统综述

Abstract:

Objective To systematically review the advantages and disadvantages of capping and non-capping decannulation strategies in adult tracheostomized patients.

Methods The PICO framework was developed. Literatures on decannulation measures in adult tracheostomized patients were searched in PubMed, EMbase, Cochrane Library, CNKI, Wanfang Database and SinoMed from establishment to February 1st, 2025. The non-capping group included patients who underwent decannulation after passing the assessment, without ≥ 24 hours of tube capping. The capping group included patients who underwent ≥ 24 hours of tube occlusion before decannulation. Study types included randomized controlled trial (RCT), cohort studies, and case-control studies. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of non-randomized studies, while the Cochrane Risk of Bias Tool was applied to assess RCTs. The GRADE was used to evaluate the evidence quality of outcome measures. Relevant information was extracted from the included studies for systematic review.

Results A total of six studies were ultimately included, published between 2003 and 2020, originating from Spain, China, Nepal, and Israel, involving 745 patients. Non-RCT studies scored six to eight points on NOS. Among RCT, one study had a low risk of bias, while another had a moderate risk based on the Cochrane Risk of Bias Tool. Capping strategies included complete capping for 24 to 48 hours before decannulation, stepwise tube downsizing followed by capping, and progressive capping prior to decannulation. Non-capping strategies involved immediate decannulation after passing the assessment or following endoscopic evaluation. Compared with the capping strategy, non-capping decannulation significantly reduced decannulation time and incidence of adverse events. No significant differences were observed in decannulation success rates or pulmonary infection rates between the two strategies. However, findings on pulmonary infections and adverse events were inconsistent across studies. According to the GRADE assessment, the strength of evidence was rated as low for decannulation success rate and decannulation time, and very low for incidence of pulmonary infection and adverse events.

Conclusion For adult tracheostomized patients, non-capping decannulation strategy appears superior to capping strategy, demonstrating shorter decannulation time and reduced adverse events. No significant difference were observed in decannulation success rates and pulmonary infection rates between the two strategies.

Key words: tracheostomy decannulation, intensive care rehabilitation, capping, systematic review

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