非藥物介入措施促進重症患者睡眠品質

Non-Pharmacological Interventions for Sleep Promotion in the Intensive Care Unit

吳純怡(Chun-Yi Wu) ； 陳惠美(Hui-Mei Chen)

《台灣醫學》 24卷5期 (2020/09) Pp. 490-499

https://doi.org/10.6320/FJM.202009_24(5).0002

摘要

加護病房患者受到自身疾病、侵入性醫療處置、護理照護、情緒困擾及外部環境等多方面因素之影響，致使重症患者普遍存在睡眠障礙。而鎮靜與止痛藥物對於病人睡眠生理容易產生不利影響，藉由非藥物照護措施以提昇重症病人的睡眠品質，更符合病人安全考量。但目前國内相關研究仍缺乏且無整合性文獻，故本文目的即以系統性文獻回顧方式，整合與評價非藥物介入措施促進重症患者睡眠品質之實證。限定2009年至2019年05月前發表的中、英文文獻，資料庫包含The Cochrane Library、PubMed、MEDLINE、PsycINFO及華藝線上圖書館，中、英文關鍵字包含：重症患者、非藥物介入措施、睡眠品質、non-pharmacological interventions、critical care、sleep quality。文獻選取標準為運用非藥物介入措施促進重症患者睡眠品質之隨機控制試驗，並以modified Jadad scale作為文章品質篩選工具，共納入7篇研究。7篇研究之研究品質介於5至6分，屬於中等品質實證研究。介入措施包含：使用眼罩及耳塞以降低光線與噪音的干擾、纈草精油穴位按摩、芳香療法或採用音樂治療介入等方式，但目前實證證據的品質與研究數量仍偏低，建議未來研究宜朝向更為嚴謹、盲化、大規模的隨機控制試驗，以持續更新此實證結果。

關鍵字

加護病房 ； 非藥物介入措施 ； 睡眠品質 ； 系統性文獻回顧

並列摘要

Critically ill patients admitted to the intensive care unit (ICU) are affected by underlying illnesses, invasive medical interventions, interruptions by nursing care, emotional distress, and hospital environments. These patients often have severe sleep disturbance. Sedatives and analgesics can have adverse effects on sleep physiology, whereas non-pharmacological interventions can safely improve sleep quality. However, research and systematic reviews in this field are lacking. We performed a systematic review to summarize the effectiveness of non-pharmacological interventions for sleep promotion. Studies published between 2009 and May 2019 were collected in the following databases: The Cochrane Library, PubMed, MEDLINE, PsycINFO, and Airiti Library. The following key search terms were used both individually and in combination: ＂non-pharmacological interventions,＂ ＂critical care,＂ and ＂sleep quality.＂ Studies were thoroughly assessed using the guidelines of the modified Jadad scale for randomized controlled trials. A total of seven articles met the criteria and were used in the present review. The seven studies had mid-level evidence quality and modified Jadad scale scores of 5 or 6. We included trials that used earplugs, eye masks, or both; valerian acupressure; aromatherapy; and music interventions. However, the quality of evidence on the use of non-pharmacological interventions for promoting sleep in adults in the ICU was low. Future studies should use more rigorous research designs, randomized controlled trials, and larger sample sizes to support these results.

並列關鍵字

intensive care unit ； non-pharmacological interventions ； sleep quality ； systematic review

參考文獻

Pisani M, Friese RS, Gehlbach BK, et al. Sleep in the intensive care unit. Am J Respir Crit Care Med 2015;191:731-8.

Boyko Y, Toft P, Ørding H, et al. Atypical sleep in critically ill patients on mechanical ventilation is associated with increased mortality. Sleep Breath 2019;23:379-88.

Delaney LJ, Van Haren, F Lopez V. Sleeping on a problem: the impact of sleep disturbance on intensive care patients-a clinical review. Ann Intensive Care 2015;5:1-10.

Solverson KJ, Easton PA, Doig CJ. Assessment of sleep quality post-hospital discharge in survivors of critical illness. Respir Med 2016;114:97-102.

Beltrami FG, Nguyen XL, Pichereau C, et al. Sleep in the intensive care unit. J Bras Pneumol 2015;41:539-46.