非药物干预比较改善ICU患者睡眠质量效果的网状Meta分析

Efficacy of non-pharmacological interventions to improve sleep quality in ICU patients:a network meta-analysis

目的采用网状Meta分析方法评价非药物干预改善ICU患者睡眠质量的效果。方法计算机检索The Cochrane Library、PubMed、EMbase、Web of Science、CNKI、WanFang Data、VIP和CBM数据库,搜集非药物干预改善ICU患者睡眠质量效果的随机对照试验(RCT),检索时限均为建库至2018年12月。由2名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Stata 13.0软件进行网状Meta分析。结果共纳入12个RCT,包括1223例患者,涉及9种非药物干预方法(音乐疗法、综合护理干预、中医情志、音乐疗法+中医情志、中药枕疗法、耳穴压豆、眼罩+耳塞+音乐、眼罩+耳塞、常规护理)。针对匹兹堡睡眠质量指数(PSQI)的网状Meta分析结果显示:在改善ICU患者睡眠质量方面,眼罩+耳塞、眼罩、综合护理干预优于常规护理,其差异有统计学意义。结果排序图显示:眼罩+耳塞>眼罩>综合护理干预、音乐疗法+中医情志>中医情志>音乐疗法>常规护理。针对Richards-Campbell睡眠量表(RCSQ)的网状Meta分析结果显示:眼罩+耳塞+音乐、中药枕疗法、耳穴压豆优于常规护理,其差异有统计学意义。结果排序图显示:眼罩+耳塞+音乐>中药枕疗法>音乐疗法>耳穴压豆>常规护理。结论当前证据显示,在改善ICU患者睡眠质量方面,眼罩+耳塞、眼罩、综合护理干预、音乐疗法+中医情志都可能是有效的干预方式,建议未来开展更多非药物干预改善ICU患者睡眠质量效果的RCT。

Objectives To assess the efficacy of non-drug interventions on improving sleep quality in ICU patients by network meta-analysis.Methods The Cochrane Library,PubMed,EMbase,Web of Science,CNKI,WanFang Data,VIP and CBM databases were electronically searched to collect randomized controlled trials(RCTs)on non-drug interventions on improving sleep quality in ICU patients from inception to December,2018.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies,then,network meta-analysis was performed by using the Stata 13.0 software.Results A total of 12 RCTs,involving 1223 patients and 9 non-pharmacological interventions(music therapy,comprehensive nursing intervention,TCM emotions,music therapy+TCM emotions,Chinese medicine pillow therapy,ear acupressure,eye mask+earplugs+music,eye mask+earplugs,regular care)were included.The results of Pittsburgh sleep quality index(PSQI)showed that eye mask+earplugs,eye masks,and comprehensive nursing interventions were superior to conventional care in improving sleep quality in ICU patients,and the rankings were:eye mask+earplugs>eye mask>comprehensive nursing intervention,music therapy+TCM emotional>Chinese medicine emotional>music therapy>general care.The results of Richards-Campbell sleep scale(RCSQ)showed that eye mask+earplugs+music,Chinese medicine pillow therapy,and auricular pressure beans were superior to conventional care,and the rankings were:eye mask+earplugs+music>Chinese medicine pillow therapy>music therapy>ear acupressure beans>general care.Conclusions The evidence shows that in improving the sleep quality of ICU patients,eye mask+earplug,eye mask,comprehensive nursing intervention,music therapy+TCM emotional characteristics may all be effective intervention methods.It is suggested that more non-drug interventions should be carried out in the future for enhancing the sleep quality of ICU patients.