家庭参与护理对患者谵妄影响的Meta分析

A Meta-Analysis of the Influence of Family Members’ Participation in Nursing on Delirium in Patients

摘要: 目的：评价家庭参与护理对患者谵妄的防治干预效果。方法：计算机检索从建库至2021年1月1日，PubMed、Embase、EBSCO、Cochrane Library、Web of Science、CINAHL、中国生物医学文献数据库、中国知网、维普中文期刊数据库和万方数据库中有关家属参与预防或干预患者谵妄的RCT研究，使用统计分析软件RevMan 5.3进行meta分析。结果：共纳入14项研究进行Meta分析，结果表明，家庭参与护理对降低患者谵妄发生率[RR = 0.44, 95% CI (0.31, 0.62), P < 0.00001]及谵妄严重程度[MD = −2.39, 95% CI (−3.87, −0.90), P = 0.002]有明显作用，对降低患者机械通气时间[MD = −2.83, 95% CI (−3.39, −2.26), P < 0.00001]以及住院时间[MD = −1.68, 95% CI (−2.87,−0.49), P = 0.006]有明显作用，对提高患者住院期间及出院后日常生活能力[MD = −14.50, 95% CI (−17.45, −11.56), P < 0.00001]有明显作用，对降低患者谵妄持续时间[MD = −0.08, 95% CI (−0.81, 0.65), P = 0.83]和焦虑评分[MD = −0.62, 95% CI (−2.34, 1.11), P = 0.48]无显著作用。结论：家庭参与护理可显示降低患者的谵妄评分及发生率、缩短住院时间和机械通气时间，并有益于患者身体机能的恢复，促进患者良好的远期预后。但对减少患者焦虑等负性心理发生率，缩短其谵妄持续时间作用不显著。由于目前可用文献有限，且国内重症监护室家属探视受限制，缺乏完善的家庭成员培养经验等局限性因素，该主题仍然是需要进一步研究的关键领域。

Abstract: Objective: To evaluate the effect of family participation nursing on prevention and treatment of delirium. Methods: Retrieved by computer from database establishment to January 1, 2021, PubMed, Embase, EBSCO, Cochrane Library, Web of Science, CINAHL, China Biomedical Literature Database, CNKI, Wanfang Database, and Weipu Chinese Journal Database on family involvement in the prevention or intervention of patients with delirium randomized controlled trials, meta-analysis was performed using RevMan 5.3 statistical software. Results: 14 studies were included for meta-analysis, and the results showed that family participation in nursing had a significant effect on reducing the incidence of delirium [RR = 0.44, 95% CI (0.31, 0.62), P < 0.00001] and the severity of delirium [MD = −2.39, 95% CI (−3.87, −0.90), P = 0.002]. It significantly reduced the duration of mechanical ventilation [MD = −2.83, 95% CI (−3.39, −2.26), P < 0.00001] and the length of hospital stay [MD = −1.68, 95% CI (−2.87, −0.49), P = 0.006]. It has a significant effect on improving the daily living ability of patients during hospitalization and after discharge [MD = −14.50, 95% CI (−17.45, −11.56), P < 0.00001], and reduces the duration of delirium [MD = −0.08, 95% CI (−0.81, 0.65), P = 0.83] and anxiety score [MD = −0.62, 95% CI (−2.34, 1.11), P = 0.48] had no significant effect. Conclusion: Family participation in nursing can reduce delirium scores and incidence of patients, shorten the length of hospital stay and mechanical ventilation, and is beneficial to the recovery of patients’ physical function and promote good long-term prognosis. However, it has no significant effect on reducing the incidence of negative psychology such as anxiety and shortening the duration of delirium. This topic remains a key area for further research due to limited available literature, limited family visitation in intensive care units in China, and lack of complete family member training experience.