ICU患者睡眠障碍危险因素的系统评价

Risk factors for sleep disorders in ICU patients: a meta-analysis

目的系统评价ICU患者睡眠障碍的危险因素。方法计算机检索The Cochrane Library、PubMed、EMbase、Web of Science、CNKI、WanFang Data、VIP和CBM数据库,搜集ICU患者睡眠障碍相关危险因素的研究,检索时限均从建库至2018年10月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入9篇文献,包括1 068例患者,涉及危险因素12个。Meta分析结果显示:设备噪音[OR=0.42,95%CI(0.26,0.68),P=0.000 4]、护理人员谈话声[OR=0.53,95%CI(0.42,0.66),P<0.000 01]、病员噪音[OR=0.39,95%CI(0.21,0.74),P=0.004]、光照[OR=0.29,95%CI(0.18,0.45),P<0.000 01]、夜间治疗[OR=0.36,95%CI(0.26,0.50),P<0.000 01]、疾病本身及药物作用[OR=0.17,95%CI(0.08,0.36),P<0.000 01]、疼痛[OR=0.37,95%CI(0.17,0.82),P=0.01]、舒适的改变[OR=0.34,95%CI(0.17,0.67),P=0.002]、焦虑[OR=0.31,95%CI(0.12,0.78),P=0.01]、探视时间[OR=0.72,95%CI(0.53,0.98),P=0.04]、经济负担[OR=0.63,95%CI(0.48,0.82),P=0.000 5]均与ICU患者睡眠障碍相关。结论当前证据显示,环境因素(护理人员谈话声、病员噪音、光照)、治疗因素(夜间治疗)、疾病因素(疾病本身及药物作用、疼痛)和心理因素(探视时间、经济负担)与ICU患者睡眠障碍相关。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the risk factors associated with sleep disorders in ICU patients.Methods We searched The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, Wanfang Data, VIP and CBM databases to collect cohort studies, case-control studies and cross-sectional studies on the risk factors associated with sleep disorders in ICU patients from inception to October, 2018. Two reviewers independently screened literature, extracted data and evaluated the bias risk of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 9 articles were included, with a total of 1 068 patients, including 12 risk factors. The results of metaanalysis showed that the combined effect of equipment noise(OR=0.42, 95%CI 0.26 to 0.68, P=0.000 4), patients’ talk(OR=0.53, 95%CI 0.42 to 0.66, P<0.000 01), patients’ noise(OR=0.39, 95%CI 0.21 to 0.74, P=0.004), light(OR=0.29,95%CI 0.18 to 0.45, P<0.000 01), night treatment(OR=0.36, 95%CI 0.26 to 0.50, P<0.000 01), diseases and drug effects(OR=0.17,95%CI 0.08 to 0.36, P<0.000 01), pain(OR=0.37, 95%CI 0.17 to 0.82, P=0.01), comfort changes(OR=0.34,95%CI 0.17 to 0.67,P=0.002), anxiety(OR=0.31,95%CI 0.12 to 0.78, P=0.01), visit time(OR=0.72, 95%CI 0.53 to0.98, P=0.04), economic burden(OR=0.63, 95%CI 0.48 to 0.82, P=0.000 5) were statistically significant risk factors for sleep disorders in ICU patients. Conclusion Current evidence shows that the risk factors for sleep disorders in ICU patients are environmental factors(talking voices of nurses, patient noise, and light), treatment factors(night treatment), disease factors(disease itself and drug effects, pain,) and psychological factors(visiting time, economic burden). Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusions.