摘要
目的:通过网状Meta分析评价不同镇静策略对重症监护病房(ICU)机械通气病人谵妄发生率的影响。方法:计算机检索PubMed、EMbase、Web of Science、the Cochrance Library、Scopus、中国知网(CNKI)、维数据库普(VIP)、万方数据库(WanFang Database)、中国生物医学文献数据库(CBM)关于不同镇静策略对ICU机械通气病人谵妄发生率影响的研究,检索时限为建库至2022年4月30日。由2名研究者独立进行文献筛选、质量评价和数据提取。采用Stata 16.0软件进行网状Meta分析。结果:共纳入25项研究,包含5种镇静策略,涉及2 838例病人。纳入研究质量均为B级。网状Meta分析结果显示,在降低ICU机械通气病人谵妄发生率方面,除每日唤醒策略外,舒适化浅镇静策略、程序性镇静策略、集束化镇静镇痛策略、目标导向性镇静策略明显优于常规镇静护理(P<0.05)。排序概率图显示程序性镇静策略对ICU机械通气病人谵妄的干预效果最佳,其次为目标导向性镇静策略。结论:现有证据表明,程序性镇静策略可能是降低ICU机械通气病人谵妄发生率的最佳干预方式,但仍需更多大样本、多中心、高质量的研究加以论证。
Objective:To evaluate the effect of different sedation strategies on the incidence of delirium in patients with mechanical ventilation in the ICU by network Meta-analysis.Methods:The research about effect of different sedation strategies on the incidence of delirium in patients with mechanical ventilation in the ICU were retrieved from PubMed,EMbase,Web of Science,the Cochrance Library,Scopus,CNKI,VIP,WanFang Database and CBM.The retrieval time was from the inception to April 30,2022.Two researchers independently carried out literature screening,quality evaluation and data extraction.Stata 16.0 software was used to perform network Meta-analysis.Results:A total of 25 studies comprising 5 sedation strategies were included,with a total of 2838 patients.The quality ratings of the included studies were all B grade.The results of the network Meta-analysis showed that comfort shallow sedation strategy,procedural sedation strategy,bundled sedation and analgesia strategy,and goal-directed sedation strategy were significantly better than conventional sedation care in reducing the incidence of delirium in patients with mechanical ventilation in the ICU,except for the daily awaking strategy(P<0.05).The ranked probability plot showed that the procedural sedation strategy was the most effective intervention for delirium in patients with mechanical ventilation in the ICU,the second was the goal-directed sedation strategy.Conclusion:Current evidence shows that procedural sedation strategy may be the best intervention to reduce the incidence of delirium in patients with mechanical ventilation in the ICU,but more large sample,multicenter,high quality studies were supposed to prove it.
作者
刘嘉龙
郭文超
滕娇
秦寒枝
LIU Jialong;GUO Wenchao;TENG Jiao;QIN Hanzhi(School of Nursing,Anhui University of Chinese Medicine,Anhui 230012 China)
出处
《循证护理》
2023年第19期3421-3427,共7页
Chinese Evidence-Based Nursing
基金
国家临床重点专科建设项目,编号:国卫办医函[2018]292号。
关键词
重症监护病房
机械通气
镇静
谵妄
网状Meta分析
intensive care unit
mechanical ventilation
sedation
delirium
network Meta-analysis
