基于循证和德尔菲法构建ICU患者睡眠管理方案
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摘要
目的提高ICU患者的睡眠质量。方法采用循证方法筛选最佳证据,经研究小组讨论构建ICU睡眠管理初步方案;采用德尔菲法向20名危重症领域医疗护理专家进行2轮函询。结果纳入12项高质量证据,构建包括失眠诊断、睡眠质量评估、睡眠危险因素评估、睡眠危险因素干预、其他提高睡眠质量措施的5个方面共11项内容的睡眠管理方案;专家积极性为100%,权威系数0.84,变异系数0.17～0.21,W值0.196、0.249,均P<0.01。结论本ICU患者睡眠管理方案构建过程严谨,结果可靠,可用于临床ICU患者的睡眠管理,以验证该管理方案的适用性。
Objective To enhance sleep quality of intensive care patients. Methods Best evidence were identified through the evidence-based nursing approach to develop sleep management protocol, then 20 experts in critical care medicine and nursing were invited to participate in a two-round of consultation using the Delphi method. Results Twelve high-quality evidence were included, and the sleep management protocol was composed of five dimensions of insomnia diagnosis, sleep quality assessment, risk factors assessment, risk factors intervention and other measures to improve sleep quality, totaling to 11 items. The response rate of experts was 100%, the coefficient of authority of the experts was 0.84, the coefficients of variation ranged from 0.17 to 0.21, and the Kendall′s coefficient of concordance was 0.196 and 0.249 in the two rounds respectively(P<0.01 for both). Conclusion The sleep management protocol is meticulously developed with high reliability for ICU patients, so it can be used to assess sleep quality of ICU patients after validation.
Objective To enhance sleep quality of intensive care patients. Methods Best evidence were identified through the evidence-based nursing approach to develop sleep management protocol, then 20 experts in critical care medicine and nursing were invited to participate in a two-round of consultation using the Delphi method. Results Twelve high-quality evidence were included, and the sleep management protocol was composed of five dimensions of insomnia diagnosis, sleep quality assessment, risk factors assessment, risk factors intervention and other measures to improve sleep quality, totaling to 11 items. The response rate of experts was 100%, the coefficient of authority of the experts was 0.84, the coefficients of variation ranged from 0.17 to 0.21, and the Kendall′s coefficient of concordance was 0.196 and 0.249 in the two rounds respectively(P<0.01 for both). Conclusion The sleep management protocol is meticulously developed with high reliability for ICU patients, so it can be used to assess sleep quality of ICU patients after validation.
引文
[1] 苏亮,陆峥.2017年中国失眠症诊断和治疗指南解读[J].世界临床药物,2018,39(4):217-222.
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[3] 宋辉,姜利.ICU患者的睡眠:现状、原因与对策[J].中华重症医学电子杂志(网络版),2017,3(4):254-257.
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[5] 刘莺莺.ICU患者的睡眠情况调查及其影响因素分析[J].世界睡眠医学杂志,2017,4(6):358-361.
[6] Freedman N S,Kotzer N,Schwab R J.Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit[J].Am J Respir Crit Care Med,1999,159(4 Pt 1):1155-1162.
[7] Giusti G D,Tuteri D,Giontella M.Nursing interactions with intensive care unit patients affected by sleep deprivation[J].Dimens Crit Care Nurs,2016,35(3):154-159.
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[9] 中国成人ICU镇痛和镇静治疗指南[J].中华重症医学电子杂志(网络版),2018,4(2):90-113.
[10] Bihari S,Doug McEvoy R,Matheson E,et al.Factors affecting sleep quality of patients in Intensive Care Unit[J].J Clin Sleep Med,2012,8(3):301-307.
[11] Hu R F,Jiang X Y,Hegadoren K M,et al.Effects of earplugs and eye masks combined with relaxing music on sleep,melatonin and cortisol levels in ICU patients:a randomized controlled trial[J].Crit Care,2015,19(1):115.
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[13] 杨慧.眼罩耳塞对ICU浅镇静患者睡眠状况的干预效果研究[D].北京:北京协和医学院,2017.
[14] 朱冰倩,李小妹.音乐疗法对睡眠质量影响的Meta分析[J].护理学杂志,2013,28(21):80-83.
[15] Schutte-Rodin S,Broch L,Buysse D,et al.Clinical guideline for the evaluation and management of chronic insomnia in adults[J].J Clin Sleep Med,2008,4(5):487-504.
[16] 科技部“十一五”国家科技支撑计划重点课题心理疾患防治研究与示范项目研究课题组.基于个体化的失眠症中医临床实践指南[J].世界睡眠医学杂志,2016,3(2):65-79.
[17] Darbyshire J L,Young J D.An investigation of sound levels on intensive care units with reference to the WHO guidelines[J].Crit Care,2013,17(5):R187.
[18] Jaiswal S J,Garcia S,Owens R L.Sound and light le-vels are similarly disruptive in ICU and non-ICU wards[J].J Hosp Med,2017,12(10):798-804.
[19] Zimmerman L,Nieveen J,Barnason S,et al.The effects of music interventions on postoperative pain and sleep in coronary artery bypass graft (CABG) patients[J].Sch Inq Nurs Pract,1996,10(2):153-174.
[20] Elliott R,Mckinley S,Cistulli P,et al.Characterisation of sleep in intensive care using 24-hour polysomnography:an observational study[J].Crit Care,2013,17(2):R46-R56.
[21] Vincent J L,Shehabi Y,Walsh T S,et al.Comfort and patient-centred care without excessive sedation:the eCASH concept[J].Intensive Care Med,2016,42(6):962-971.
[22] 向邱,徐素琴,陈华文,等.重症监护室患者睡眠剥夺的集束护理干预策略[J].护理学杂志,2013,28(11):32-33.
[23] Tan H J,Lan Y,Wu F S,et al.Auricular acupuncture for primary insomnia:a systematic review based on GRADE system[J].Zhongguo Zhen Jiu,2014,34(7):726-730.
[24] 徐静茹.穴位贴敷疗法治疗失眠症临床观察[J].中西医结合心血管病电子杂志,2018,6(9):143-146.
[2] Riemann D,Baglioni C,Bassetti C,et al.European guideline for the diagnosis and treatment of insomnia[J].J Sleep Res,2017,26(6):675-700.
[3] 宋辉,姜利.ICU患者的睡眠:现状、原因与对策[J].中华重症医学电子杂志(网络版),2017,3(4):254-257.
[4] Friese R S.Sleep and recovery from critical illness and injury:a review of theory,current practice,and future directions[J].Crit Care Med,2008,36(3):697-705.
[5] 刘莺莺.ICU患者的睡眠情况调查及其影响因素分析[J].世界睡眠医学杂志,2017,4(6):358-361.
[6] Freedman N S,Kotzer N,Schwab R J.Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit[J].Am J Respir Crit Care Med,1999,159(4 Pt 1):1155-1162.
[7] Giusti G D,Tuteri D,Giontella M.Nursing interactions with intensive care unit patients affected by sleep deprivation[J].Dimens Crit Care Nurs,2016,35(3):154-159.
[8] 陈丽霞.中文版理查兹-坎贝尔睡眠量表的信效度研究及临床应用评价[D].大连:大连大学,2017.
[9] 中国成人ICU镇痛和镇静治疗指南[J].中华重症医学电子杂志(网络版),2018,4(2):90-113.
[10] Bihari S,Doug McEvoy R,Matheson E,et al.Factors affecting sleep quality of patients in Intensive Care Unit[J].J Clin Sleep Med,2012,8(3):301-307.
[11] Hu R F,Jiang X Y,Hegadoren K M,et al.Effects of earplugs and eye masks combined with relaxing music on sleep,melatonin and cortisol levels in ICU patients:a randomized controlled trial[J].Crit Care,2015,19(1):115.
[12] Locihova H,Axmann K,Padysakova H,et al.Effect of the use of earplugs and eye mask on the quality of sleep in intensive care patients:a systematic review[J].J Sleep Res,2018,27(3):e12607-e12619.
[13] 杨慧.眼罩耳塞对ICU浅镇静患者睡眠状况的干预效果研究[D].北京:北京协和医学院,2017.
[14] 朱冰倩,李小妹.音乐疗法对睡眠质量影响的Meta分析[J].护理学杂志,2013,28(21):80-83.
[15] Schutte-Rodin S,Broch L,Buysse D,et al.Clinical guideline for the evaluation and management of chronic insomnia in adults[J].J Clin Sleep Med,2008,4(5):487-504.
[16] 科技部“十一五”国家科技支撑计划重点课题心理疾患防治研究与示范项目研究课题组.基于个体化的失眠症中医临床实践指南[J].世界睡眠医学杂志,2016,3(2):65-79.
[17] Darbyshire J L,Young J D.An investigation of sound levels on intensive care units with reference to the WHO guidelines[J].Crit Care,2013,17(5):R187.
[18] Jaiswal S J,Garcia S,Owens R L.Sound and light le-vels are similarly disruptive in ICU and non-ICU wards[J].J Hosp Med,2017,12(10):798-804.
[19] Zimmerman L,Nieveen J,Barnason S,et al.The effects of music interventions on postoperative pain and sleep in coronary artery bypass graft (CABG) patients[J].Sch Inq Nurs Pract,1996,10(2):153-174.
[20] Elliott R,Mckinley S,Cistulli P,et al.Characterisation of sleep in intensive care using 24-hour polysomnography:an observational study[J].Crit Care,2013,17(2):R46-R56.
[21] Vincent J L,Shehabi Y,Walsh T S,et al.Comfort and patient-centred care without excessive sedation:the eCASH concept[J].Intensive Care Med,2016,42(6):962-971.
[22] 向邱,徐素琴,陈华文,等.重症监护室患者睡眠剥夺的集束护理干预策略[J].护理学杂志,2013,28(11):32-33.
[23] Tan H J,Lan Y,Wu F S,et al.Auricular acupuncture for primary insomnia:a systematic review based on GRADE system[J].Zhongguo Zhen Jiu,2014,34(7):726-730.
[24] 徐静茹.穴位贴敷疗法治疗失眠症临床观察[J].中西医结合心血管病电子杂志,2018,6(9):143-146.