背景:重症监护病房(ICU)患者及其家人的心理健康和睡眠质量对健康有影响,应更加重视制定有效的干预措施来解决这些问题。由于ICU日记干预的证据越来越多,应评估其相对有效性。
目的:本系统综述和荟萃分析旨在评估ICU日记对危重病患者心理障碍和睡眠质量的影响以及对其家庭成员心理障碍的影响。
方法:PubMed,Embase,WebofScience,科克伦图书馆,中国生物医学文献数据库,中国全民知网,万方数据库,截至2023年11月,我们搜索了WeipuChineseJournal数据库,以确定随机对照试验。我们使用Cochrane偏差风险工具进行质量评估,我们使用ReviewManager5.4软件进行荟萃分析。
结果:11项研究共1682例患者符合纳入标准。
方法:创伤后应激障碍(7项研究,1015例患者):OR0.63(95CI0.45-0.87),p=0.005;焦虑(6项研究,546例患者):OR0.52(95CI0.22-1.27),p=0.15;抑郁症(6项研究,546例患者):OR0.62(95CI0.39-0.97),p=0.04;睡眠质量(2项研究,203名患者):OR-3.97(95CI-7.71-0.23),p=0.04。家庭成员:PTSD(2项研究,652名患者):OR0.81(95CI0.37-1.79),p=0.60;焦虑(2项研究,650个家庭成员):OR1.09(95CI0.79-1.49),p=0.62;抑郁症(2项研究,650名患者):OR1.03(95CI0.71-1.50),p=0.87。汇总的荟萃分析结果显示,ICU日记降低了抑郁症和创伤后应激障碍的发生率,改善了患者的睡眠质量,但对患者的焦虑状态或家庭成员的心理障碍没有显著影响。纳入的三项研究质量很高,其余8项研究质量中等.
结论:对于患者,ICU日记可以改善他们的抑郁和创伤后应激障碍,改善睡眠质量,但对焦虑没有显著影响;对家庭成员来说,ICU日记不明显。由于偏倚的存在和样本量有限,结果应谨慎解释.研究人员需要进一步阐明ICU中基于日记的治疗的多学科协作过程及其对家庭成员心理障碍的影响。此外,大规模,多中心,未来应该进行强有力的研究。
BACKGROUND: The psychological health and sleep quality of intensive care unit (ICU) patients and their families have health implications, and greater attention should be devoted to developing effective interventions to address these concerns. Due to an increasing amount of evidence on ICU diary interventions, their comparative effectiveness should be evaluated.
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effect of ICU diaries on psychological disorders and sleep quality in critically ill patients and on psychological disorders in their family members.
METHODS: The PubMed, Embase, Web of Science, Cochrane Library, China Biomedical Literature Database, China National Knowledge Network, Wanfang Database, and Weipu Chinese Journal databases were searched up to November 2023 to identify randomized controlled trials. We used the Cochrane Risk of Bias Tool for quality assessment, and we used Review Manager 5.4 software to conduct meta-analysis.
RESULTS: Eleven studies with a total of 1682 patients met the inclusion criteria.
METHODS: PTSD (7 studies, 1015 patients): OR 0.63 (95%CI 0.45-0.87), p = 0.005; Anxiety (6 studies, 546 patients): OR 0.52 (95%CI 0.22-1.27), p = 0.15; Depression (6 studies, 546 patients): OR 0.62 (95%CI 0.39-0.97), p = 0.04; sleep quality (2 studies, 203 patients): OR -3.97 (95%CI -7.71-0.23), p = 0.04. Family members: PTSD (2 studies, 652 patients): OR 0.81 (95%CI 0.37-1.79), p = 0.60; Anxiety (2 studies, 650 family members): OR 1.09 (95%CI 0.79-1.49), p = 0.62; Depression (2 studies, 650 patients): OR 1.03 (95%CI 0.71-1.50), p = 0.87. The pooled results of the meta-analysis showed that ICU diaries reduced the incidence of depression and post-traumatic stress disorder and improved sleep quality in patients, but had no significant effects on patients\' anxiety status or family members\' psychological disorders. Three of the included studies had a high quality, and the remaining eight studies had a moderate quality.
CONCLUSIONS: For patients, ICU diaries can improve their depression and post-traumatic stress disorder, improve sleep quality, but has no significant effect on anxiety; For family members, ICU diaries were not significant. Due to the existence of bias and the limited sample size, the results should be interpreted with caution. Researchers need to further elucidate the multidisciplinary collaborative process of diary-based treatment in ICUs and its impact on psychological disorders in family members. Furthermore, large-scale, multicentre, robust studies should be conducted in the future.