| 摘要: | 研究目的：以網絡統合分析方式檢視與比較不同的非藥物介入措施對於改善加護病房病人焦慮之成效。
研究設計：隨機臨床試驗之系統性文獻文顧及網絡統合分析
研究方法：本研究以系統性文獻回顧方式，蒐集以非藥物介入措施改善加護病房病人焦慮之隨機臨床試驗，藉由網絡統合分析方式進行進一步治療效果比較。本研究於PubMed、Embase、ProQuest三個電子資料庫進行文獻檢索至2023年07月23日，納入之文獻不限年份及語言。經由兩位研究者獨立根據Cochrane risk of bias tool, RoB 2.0進行文獻品質評讀。本研究將使用R 4.3.1統計軟體進行統計分析，採頻率分析學派下隨機效應模型。
研究結果：本研究共納入34篇隨機分派試驗研究進行網絡統合分析，包含七種非藥物介入措施，總樣本數共2528人，平均年齡約為55.05歲，女性性別比約為47.94%，針對加護病房焦慮，納入34篇研究。結果顯示，與常規照護組相比，虛擬實境、音樂介入與芳香療法可降低加護病房病人的焦慮（-3.26, 95% confidence interval = -6.08 to -0.43; -1.91, -2.42 to -1.29; -1.59, -2.41 to -0.77 ）；而相較於常規照護組，音樂介入可降低加護病房病人的心跳速率（-3.23, -9.36 to -1.41）及呼吸速率（-1.79, -2.68 to -0.91）。P分數結果顯示：虛擬實境（0.97）為改善加護病房焦慮排序第一，其次是音樂介入（0.76），芳香療法（0.65）排名第三；音樂介入對於降低心跳速率（0.85）與對於降低呼吸速率（0.87）排序皆為第一。
結論與建議：考量到虛擬實境的設備價格高昂且不易取得，建議加護病房護理人員可將音樂介入及芳香療法整合作為每日照護之一環以緩解焦慮。
Purpose: To examine and compare the effects of various non-pharmacological interventions in alleviating anxiety in critically ill patients.
Method: This study was a systematic review of randomized clinical trials focusing on non-pharmacological interventions for reducing anxiety in intensive care unit (ICU) patients. Through network meta-analysis, a comparative analysis of treatment effects was performed. Three electronic databases, including the PubMed, Embase, and ProQuest were searched from their inception to 23 July 2023, without restrictions on publication year or language. Two independent researchers independently assessed searched, screened, and extracted eligible articles and adopted the Cochrane Risk of Bias tool 2.0 to assess study quality. R 4.3.1 statistical software was used to conduct data analysis which under a random effects model with frequentist framework.
Result: Thirty-Four randomized controlled trials were included. The sample size was 2528, with mean age of 55.05 and female percentage of 47.94%. Seven non-pharmacological interventions were included. The results showed that compared with routine care, virtual reality, music intervention, and aromatherapy significantly mitigated anxiety among patients admitted to ICUs (-3.26, 95% confidence interval = -6.08 to -0.43; -1.91, -2.42 to -1.29; and -1.59, -2.41 to -0.77), respectively. Music intervention significantly reduced heart rate (-3.23, -9.36 to -1.41) and respiratory rate (-1.79, -2.68 to -0.91) of patients in ICUs. The findings of P score indicated that virtual reality was ranked best (0.97) for alleviating anxiety, followed by music intervention (0.76), and aromatherapy (0.65); music intervention was ranked the first for reducing heart rate (0.85) and respiratory rate (0.87) among the included interventions.
Conclusion: Considering the features of high cost and low accessibility of virtual reality, we suggest that music intervention and aromatherapy can be integrated into daily care for reducing anxiety of critically ill patients. |
