背景:由于各种因素,例如泪液产生减少和保护机制受损,重症监护病房(ICU)患者的眼表损伤风险增加。尽管眼部护理在ICU环境中具有重要意义,对有效的干预措施缺乏共识,导致眼表疾病(OSD)的预防不足。
目的:本系统综述旨在评估ICU患者眼部护理预防OSD的有效性。次要目标包括确定眼外伤的主要危险因素并检查最有效的预防方法。
方法:遵循PRISMA指南进行了系统评价,包括文献检索,文章选择,质量评估和数据综合。符合纳入标准的研究是观察性研究和临床试验,重点是在镇静和接受机械通气的ICU入院的成年人。
结果:在3545篇最初确定的文章中,12项研究符合纳入标准。这些研究共涉及1853名参与者。评估了各种干预措施,包括盐水冲洗,润滑滴,凝胶润滑剂,用聚乙烯敷料闭塞,被动眨眼和眼睑闭合带胶带。每6小时一次的湿室闭塞与凝胶润滑相结合,是预防OSD的最有效方法。
结论:凝胶润滑与湿室闭塞被证明是预防ICU患者眼部损伤的最有效策略。相反,常规使用生理盐水与角膜病变严重程度增加相关.正确定义的协议和训练有素的护理团队对于减少ICU环境中的眼外伤至关重要。
结论:研究结果强调了在ICU中实施基于证据的眼部护理方案的重要性,强调使用凝胶润滑和眼表保护来减轻OSD的风险。这凸显了对ICU护理人员进行全面培训计划的必要性,以确保最佳的眼部护理服务。
BACKGROUND: Intensive care unit (ICU) patients are at an increased risk of ocular surface injuries because of various factors such as reduced tear production and impaired protective mechanisms. Despite the significance of ocular care in ICU settings, there is a lack of consensus on effective interventions, leading to inadequate prevention of ocular surface disease (OSD).
OBJECTIVE: This systematic review aimed to assess the effectiveness of nursing eye care in preventing OSD in ICU patients. Secondary objectives included identifying primary risk factors for ocular injuries and examining the most effective preventive methods.
METHODS: A systematic review following PRISMA guidelines was conducted, encompassing a literature search, article selection, quality assessment and data synthesis. Studies meeting inclusion criteria were observational studies and clinical trials, focusing on adults admitted to ICUs under sedation and receiving mechanical ventilation.
RESULTS: Of 3545 initially identified articles, 12 studies met inclusion criteria. These studies involved a total of 1853 participants. Various interventions were assessed, including saline rinsing, lubricating drops, gel lubricants, occlusion with polyethylene dressing, passive blinking and eyelid closure with tape. Moist chamber occlusion every 6 h combined with gel lubrication emerged as the most effective method in preventing OSD.
CONCLUSIONS: Gel lubrication along with moist chamber occlusion proved to be the most effective strategy in preventing ocular injuries in ICU patients. Conversely, the routine use of physiological saline was associated with increased severity of corneal lesions. Properly defined protocols and well-trained nursing teams are crucial for reducing ocular injuries in ICU settings.
CONCLUSIONS: The findings underscore the importance of implementing evidence-based eye care protocols in ICUs, emphasizing the use of gel lubrication and ocular surface protection to mitigate the risk of OSD. This highlights the need for comprehensive training programmes for ICU nursing staff to ensure optimal ocular care delivery.