Kourouche Sarah, Buckley Thomas, Munroe Belinda, Curtis Kate
Faculty of Nursing and Midwifery (Sydney Nursing School), The University of Sydney, Mallet St., Camperdown, NSW, Australia.
Faculty of Nursing and Midwifery (Sydney Nursing School), The University of Sydney, Mallet St., Camperdown, NSW, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St., Wollongong, NSW, Australia.
Injury. 2018 Jun;49(6):1008-1023. doi: 10.1016/j.injury.2018.03.037. Epub 2018 Apr 7.
Blunt chest injuries (BCI) are associated with high rates of morbidity and mortality. There are many interventions for BCI which may be able to be combined as a care bundle for improved and more consistent outcomes.
To review and integrate the BCI management interventions to inform the development of a BCI care bundle.
A structured search of the literature was conducted to identify studies evaluating interventions for patients with BCI. Databases MEDLINE, CINAHL, PubMed and Scopus were searched from 1990-April 2017. A two-step data extraction process was conducted using pre-defined data fields, including research quality indicators. Each study was appraised using a quality assessment tool, scored for level of evidence, then data collated into categories. Interventions were also assessed using the APEASE criteria then integrated to develop a BCI care bundle.
Eighty-one articles were included in the final analysis. Interventions that improved BCI outcomes were grouped into three categories; respiratory intervention, analgesia and surgical intervention. Respiratory interventions included continuous positive airway pressure and high flow nasal oxygen. Analgesia interventions included regular multi-modal analgesia and paravertebral or epidural analgesia. Surgical fixation was supported for use in moderate to severe rib fractures/BCI. Interventions supported by evidence and that met APEASE criteria were combined into a BCI care bundle with four components: respiratory adjuncts, analgesia, complication prevention, and surgical fixation.
The key components of a BCI care bundle are respiratory support, analgesia, complication prevention including chest physiotherapy and surgical fixation.
钝性胸部损伤（BCI）的发病率和死亡率很高。针对BCI有许多干预措施，这些措施可能可以组合成一个护理套餐，以改善并使结果更具一致性。
回顾并整合BCI管理干预措施，为制定BCI护理套餐提供依据。
对文献进行结构化检索，以识别评估BCI患者干预措施的研究。检索了1990年至2017年4月的MEDLINE、CINAHL、PubMed和Scopus数据库。使用预定义的数据字段进行两步数据提取过程，包括研究质量指标。每项研究都使用质量评估工具进行评估，根据证据水平评分，然后将数据整理成类别。干预措施还使用APEASE标准进行评估，然后整合以制定BCI护理套餐。
最终分析纳入了81篇文章。改善BCI结果的干预措施分为三类：呼吸干预、镇痛和手术干预。呼吸干预包括持续气道正压通气和高流量鼻导管给氧。镇痛干预包括定期多模式镇痛和椎旁或硬膜外镇痛。支持对中度至重度肋骨骨折/BCI使用手术固定。有证据支持且符合APEASE标准的干预措施被组合成一个包含四个组成部分的BCI护理套餐：呼吸辅助、镇痛、并发症预防和手术固定。
BCI护理套餐的关键组成部分是呼吸支持、镇痛、包括胸部物理治疗的并发症预防和手术固定。
