ICU日记对患者及家属心理健康干预效果的Meta分析

doi:10.3761/j.issn.0254-1769.2020.07.025

摘要/Abstract

摘要：

目的评价ICU日记对ICU患者和家属心理健康状况的干预效果。方法计算机检索从建库至2019年9月PubMed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、万方数据库和维普中文期刊数据库中有关ICU日记在ICU患者或家属中应用效果的随机对照研究,使用RevMan 5.3统计软件进行Meta分析。结果纳入8项研究进行Meta分析,结果显示,ICU日记对降低患者创伤后应激障碍[RR=0.65（95%CI为0.51~0.82）,P<0.001]及抑郁发生率[RR=0.65（95%CI为0.45~0.92）,P=0.02]有明显作用,对降低患者焦虑发生率[RR=0.69（95%CI为0.31~1.52）,P=0.36]以及患者家属的创伤后应激障碍发生率[RR=0.76（95%CI为0.33~1.74）,P=0.51]无明显作用。描述性分析显示,ICU日记对降低患者家属的焦虑和抑郁发生率也无显著作用。结论 ICU日记可降低ICU患者创伤后应激障碍和抑郁发生率,但对降低ICU患者焦虑及家属的创伤后应激障碍、焦虑和抑郁的作用不显著。由于纳入研究的方法限制、研究数量较少,未来尚需开展更多高质量、大样本的原始研究,以进一步评价其应用效果。

关键词: 重症监护室, 日记法, 重症患者, 创伤后应激障碍, Meta分析

Abstract:

Objective To evaluate the effectiveness of ICU diary on mental health status of ICU patients and their family members. Methods Randomized controlled trials on the effectiveness of ICU diary on post-traumatic stress disorder, anxiety and depression of ICU patients and their family members were retrieved from electronic databases of PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wanfang data and VIP. RevMan 5.3 software was used to perform meta-analysis. Results 8 studies were included for systematic review and meta-analysis. The results showed that ICU diary group reported significantly lower incidences of post-traumatic stress disorder[RR=0.65（95%CI:0.51~0.82）, P<0.001] and depression[RR=0.65（95%CI:0.45~0.92）, P=0.02]. There was no significant difference between anxiety[RR=0.69（95%CI:0.31~1.52）, P=0.36] among ICU patients and post-traumatic stress disorder[RR=0.76（95%CI:0.33~1.74）, P=0.51] among family members of ICU patients. In addition, there is no significant difference in the incidences of depression and anxiety among family members according to descriptive analysis. Conclusion ICU diary could reduce the incidence of post-traumatic stress disorder and depression among ICU patients but not the incidence of post-traumatic stress disorder, depression, anxiety among family members. Due to the limitations of methodological quality and sample size of the included studies, the original studies with high quality and large sample size are still needed to be carried out in the future to further evaluate the effectiveness of ICU diary.

Key words: Intensive Care Unit, Diary, Critically Ill Patient, Post-Traumatic Stress Disorder, Meta-Analysis

李真, 吴欣娟, 杨慧, 郭娜, 李莉, 徐梅, 李奇, 李尊柱, 孙建华, 罗红波. ICU日记对患者及家属心理健康干预效果的Meta分析[J]. 中华护理杂志, 2020, 55(7): 1091-1096.

LI Zhen, WU Xinjuan, YANG Hui, GUO Na, LI Li, XU Mei, LI Qi, LI Zunzhu, SUN Jianhua, LUO Hongbo. The effectiveness of ICU diary on mental health status of ICU patients and their family members:a systematic review and meta-analysis[J]. Chinese Journal of Nursing, 2020, 55(7): 1091-1096.

图/表 5

表1 纳入文献的基本特征

表2 纳入文献的方法学质量评价

图1 ICU日记对患者创伤后应激障碍发生率的影响

图2 ICU日记对患者创伤后应激障碍得分的影响

图3 ICU日记对患者抑郁发生率的影响

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