ICU日记对重症监护室患者创伤后应激障碍及焦虑、抑郁影响的Meta分析

Effects of ICU diary on post-traumatic stress disorder,anxiety and depression in ICU patients:a meta-analysis

目的:系统评价ICU日记对重症监护室患者出院后创伤后应激障碍、焦虑和抑郁发生情况的影响。方法:检索Cochrane Library、PubMed、Embase、中国知网(CNKI)、万方(Wanfang)和维普(VIP)数据库中有关ICU日记对重症监护室患者干预的随机对照研究,主要结局指标为创伤后应激障碍、焦虑和抑郁发生率,检索时限从建库至2021年7月。使用Cochrane偏倚风险评估工具对纳入的研究进行质量评价,采用Revman 5.3进行数据分析。结果:最终共纳入12项随机对照研究,共1397例患者。结果表明,ICU日记可以降低重症监护室患者的创伤后应激障碍发生率[OR=0.46,95%CI(0.34,0.61),P<0.01]和抑郁的发生率[OR=0.62,95%CI(0.39,0.97),P=0.04],但对焦虑发生率无影响[OR=0.52,95%CI(0.22,1.27),P=0.15]。结论:ICU日记可以改善成人重症监护病房患者出院后的创伤后应激障碍和抑郁状态,但对患者焦虑状态的影响还需进行更多高质量研究进一步验证。

Objective:To systematically evaluate the impact of ICU diary on the incidence of post-traumatic stress disorder,anxiety,and depression after discharge from the intensive care unit.Methods:Cochrane Library,PubMed,Embase,CNKI,Wanfang,and VIP databases were searched for randomized controlled studies of ICU diary interventions for patients in the intensive care unit.The main outcome indicators include the incidence of post-traumatic stress disorder,anxiety and depression.The literatures were retrieved from inception to July 2021.The Cochrane bias risk assessment tool was used to evaluate the quality of the included studies,and Revman 5.3 was used for data analysis.Results:A total of 12 randomized controlled studies and 1397 patients were ultimately included.The results show that ICU diary can reduce the incidence of post-traumatic stress disorder in intensive care unit patients[OR=0.46,95%CI(0.34,0.61),P<0.01],and the incidence of depression[OR=0.62,95%CI(0.39,0.97),P=0.04],but it has no significant effect on the incidence of anxiety[OR=0.52,95%CI(0.22,1.27),P=0.15].Conclusion:ICU diary can improve the post-traumatic stress disorder and depression of intensive care unit patients after discharge,but the impact on patients’anxiety needs to be further verified by more high-quality studies.