ICU患者谵妄非药物管理相关指南的系统评价

doi:10.16460/j.issn1008-9969.2020.11.026

摘要/Abstract

摘要： 目的系统评价ICU患者谵妄非药物管理相关指南。方法计算机检索国内外指南网、相关学会网站和数据库,搜集ICU患者谵妄非药物管理相关指南,检索时限均为建库至2019年9月30日。由2名研究者独立筛选文献、提取资料后,采用指南研究与评价工具AGREE II对纳入的指南进行质量评价,汇总各指南的推荐意见并比较其异同。结果最终纳入10部指南,9部来源于国外,10部指南AGREE II 各领域的平均得分为：范围和目的83%、参与人员55%、严谨性61%、清晰性82%、应用性65%和独立性38%,4部指南总体质量评价为A级,6部指南总体质量评价为B级。推荐意见涉及危险因素辨识和风险预测;评估与诊断;非药物预防;非药物治疗及(会)转诊与随访5个方面。结论纳入的指南质量处于中等至较高水平,但在指南的参与人员、严谨性、应用性和独立性领域仍有待完善。目前,我国ICU患者谵妄非药物管理指南的开发尚处于起步阶段,应尽快制定适用于我国ICU患者的谵妄非药物管理指南。

关键词: ICU, 谵妄, 非药物管理, 指南, 系统评价

Abstract: Objective To systematically review the guidelines on non-pharmacological management of delirium in ICU patients. Methods The guideline networks, association websites and databases were electronically searched to collect guidelines on non-pharmacological management of delirium in ICU patients from the inception to 30 September 2019. Two reviewers worked independently to screen literature, extract data, and evaluate the included guidelines according to the standard quality appraisal tool AGREE II, and then summarized and compared the recommendations related to non-pharmacological management of delirium in ICU patients. Results Ten guidelines were included and nine of them were foreign ones. The average score of each AGREE II domain was 83% for scope and purpose, 55% for stakeholder involvement, 61% for rigor of development, 82% for clarity of presentation, 65% for applicability, and 38% for editorial independence. Four guidelines rated as Grade A and the remaining six as Grade B. Five aspects were involved in recommendations, including identification of risk factors and risk prediction; assessment and diagnosis; non-pharmacological prevention; non-pharmacological treatment and (Consultation) Referral and follow-up. Conclusion The overall quality of included guidelines is in a moderate to high level. More efforts are needed to improve the stakeholder involvement, rigor of development, applicability and independence domain of guidelines. At present, the development of guidelines on non-pharmacological management of delirium in ICU patients in China is still at initial stage. It is suggested to formulate localized guidelines that are suitable for China as soon as possible.

Key words: ICU, delirium, non-pharmacological management, guideline, systematic review

中图分类号:

R473

张爱琴, 陈俊杉, 余金甜. ICU患者谵妄非药物管理相关指南的系统评价[J]. 护理学报, 2020, 27(11): 26-32.

ZHANG Ai-qin, CHEN Jun-shan, YU Jin-tian. Guidelines on Non-pharmacological Management of Delirium in ICU Patients：A Systematic Review[J]. Journal of Nursing, 2020, 27(11): 26-32.

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