ICU患者谵妄强化护理干预的网状Meta分析。
完整摘要 · 中文译文
背景：重症监护病房（ICU）中谵妄的患病率很高。已实施强化护理干预措施以减少ICU患者的谵妄。目前有多种可用于治疗谵妄的强化护理干预措施。然而，最佳干预措施仍然未知。本系统评价和网络荟萃分析（NMA）旨在比较强化护理干预对谵妄患者的疗效。 方法：我们纳入了ICU中针对谵妄的不同强化护理干预措施的随机对照试验。进行了贝叶斯网络荟萃分析，以评估各种类型的强化护理干预措施的疗效。评估的结局指标为不同治疗的治愈率、重症监护谵妄筛查量表（ICDSC）评分和急性生理与慢性健康评估II（APACHE II）评分。 结果：本荟萃分析纳入21项研究。我们共分析了5种不同的强化护理干预：耳穴按压、音乐疗法、认知功能锻炼、常规护理、增加探视时间和针对性护理。与常规护理相比，其他5种强化护理干预在治愈率、ICDSC和APACHE II评分方面均无显著差异（P > .05）。耳穴按压在治愈率和APACHE II的累积排序曲线下面积值最高，表明其在这些结局中排名第一。音乐疗法在降低ICDSC方面表现出最有益的效果，音乐疗法在此方面排名第一。结论：本网络荟萃分析（NMA）表明，耳穴按压可能是提高ICU谵妄患者治愈率、降低ICDSC和APACHE II评分的最佳干预措施。然而，累积排序曲线下面积值反映的是相对排名而非绝对疗效，且没有任何干预措施显示出相对于常规护理的统计学显著优势。此外，增加探视时间似乎有望成为减少ICU谵妄的有效干预措施。需要进一步的研究和更大规模的研究来证实这些发现，并探索这些强化护理干预在谵妄管理中的长期益处。
完整摘要 · 英文原文
BACKGROUND: Delirium prevalence in the intensive care unit (ICU) is high. Intensive nursing interventions have been performed to reduce delirium in ICU patients. There is now a wide variety of intensive nursing interventions available for treating delirium. However, the optimal intervention remains unknown. This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of intensive nursing interventions in patients with delirium. METHODS: We included randomized controlled trials of different intensive nursing interventions for delirium in the ICU. A Bayesian NMA was conducted to evaluate the efficacy of various types of intensive nursing interventions. The outcomes assessed were the cure rate, intensive care delirium screening checklist (ICDSC) scores, and acute physiologic assessment and chronic health evaluation II (APACHE II) scores for different treatments. RESULTS: This meta-analysis included 21 studies. We analyzed a total of 5 different intensive nursing interventions: auricular points acupressure, music therapy, cognitive function exercise, regular nursing, increasing visiting hours, and targeted nursing. When compared with regular nursing, the other 5 intensive nursing interventions showed no significant difference in cure rate, ICDSC, and APACHE II scores (P > .05). Auricular points acupressure had the highest surface under the cumulative ranking area value for cure rate and APACHE II, indicating it ranked first in these outcomes. Music therapy demonstrated the most favorable effect on reducing ICDSC, with music therapy ranking first in this regard. CONCLUSION: This NMA suggests that auricular points acupressure might be the optimal intervention for increasing the cure rate and decreasing ICDSC and APACHE II scores in ICU patients with delirium. However, the surface under the cumulative ranking area values reflect relative ranking rather than absolute efficacy, and no intervention demonstrated statistically significant superiority over regular nursing. Additionally, increasing visiting hours appears to hold promise as an effective intervention for reducing delirium in the ICU. Further research and larger studies are warranted to confirm these findings and to explore the long-term benefits of these intensive nursing interventions in delirium management.