家庭参与预防重症患者谵妄：一项系统评价和荟萃分析。
Family involvement in preventing delirium in critically ill patients: A systematic review and meta-analysis.
作者信息
Li Jiaqi, Fan Yingying, Luo Ruoyu, Wang Yangyang, Yin Na, Qi Wenhao, Huang Tiancha, Zhang Ju, Jing Jiyong
机构信息
Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; Hangzhou Normal University Department of Nursing, Zhejiang 311121, China.
School of Nursing, Zhejiang Chinese Medical University, Zhejiang 310053, China.
出版信息
Int J Nurs Stud. 2025 Jan;161:104937. doi: 10.1016/j.ijnurstu.2024.104937. Epub 2024 Oct 28.
BACKGROUND
Humanized care is a novel concept in the prevention of delirium, with family involvement being a crucial component. Currently, there is controversy regarding the effectiveness of family involvement in preventing delirium among critically ill patients, and the impact of varying levels of family involvement on delirium prevention remains unclear.
OBJECTIVE
The purpose of this study is twofold: (a) to investigate the influence of family involvement on delirium among critically ill patients, and (b) to explore the effectiveness of different levels of family involvement in preventing delirium in these patients.
DESIGN
A systematic review and meta-analysis.
METHODS
From database inception to July 2024, a comprehensive search was conducted across PubMed, EMBASE, CINAHL, Web of Science, and the Cochrane CENTRAL database. Randomized controlled trials that examined family involvement were included in the review.
RESULTS
This review included a total of 11 randomized controlled trials, encompassing 3113 critically ill patients. Family involvement was found to significantly reduce the incidence of delirium among critically ill patients (RR = 0.46, 95%CI = 0.31 to 0.69), decrease the duration of delirium (WMD = -2.18, 95 % CI = -4.14 to -0.22), and shorten the length of Intensive Care Unit (ICU) stay (WMD = -1.46, 95%CI = -2.43 to -0.50). Three different levels of family involvement-direct participation in care (RR = 0.37, 95%CI = 0.26 to 0.51), family visits and companionship (RR = 0.56, 95 % CI = 0.25 to 1.25), and indirect participation (RR = 0.77, 95 % CI = 0.29 to 2.07)-varies in their effectiveness for delirium prevention.
CONCLUSIONS
Family involvement significantly impacts delirium prevention in critically ill patients. The effectiveness of delirium prevention varies depending on the level of family involvement, with direct participation of family members in caregiving demonstrating a more pronounced effect in reducing delirium incidence among critically ill patients.
REGISTRATION
The review protocol has been registered in the PROSPERO International prospective register of systematic reviews (CRD42024563095).
背景
人性化护理是预防谵妄的一个新概念，家庭参与是其中的关键组成部分。目前，关于家庭参与对重症患者谵妄预防效果存在争议，且不同程度的家庭参与对谵妄预防的影响尚不清楚。
目的
本研究有两个目的：（a）调查家庭参与对重症患者谵妄的影响；（b）探讨不同程度的家庭参与对这些患者预防谵妄的效果。
设计
系统评价和荟萃分析。
方法
从数据库建立至2024年7月，对PubMed、EMBASE、CINAHL、Web of Science和Cochrane CENTRAL数据库进行全面检索。纳入审查的是考察家庭参与情况的随机对照试验。
结果
本综述共纳入11项随机对照试验，涵盖3113例重症患者。发现家庭参与可显著降低重症患者谵妄的发生率（风险比=0.46，95%置信区间=0.31至0.69），缩短谵妄持续时间（加权均数差=-2.18，95%置信区间=-4.14至-0.22），并缩短重症监护病房（ICU）住院时间（加权均数差=-1.46，95%置信区间=-2.43至-0.50）。三种不同程度的家庭参与——直接参与护理（风险比=0.37，95%置信区间=0.26至0.51）、家庭探访和陪伴（风险比=0.56，95%置信区间=0.25至1.25）以及间接参与（风险比=0.77，95%置信区间=0.29至2.07）——在预防谵妄方面的效果各不相同。
结论
家庭参与对重症患者谵妄预防有显著影响。谵妄预防效果因家庭参与程度而异，家庭成员直接参与护理在降低重症患者谵妄发生率方面效果更为显著。
注册
该综述方案已在PROSPERO国际前瞻性系统评价注册库（CRD42024563095）中注册。
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