共同决策对重症患者的影响:系统性审查和元分析
Yangyang Wang1,2, Jiaqi Li1, Na Yin1
1Department of Public Health and Nursing, Hangzhou Normal University, Zhejiang, China.
Frontiers in medicine
|February 16, 2026
概括
共享决策 (SDM) 对重症患者的死亡率或整体住院时间 (LOS) 没有影响. 然而,SDM与已故患者的重症监护室 (ICU) LOS减少有关.
科学领域:
- 关键护理医学 关键护理医学
- 医疗保健服务研究 医疗服务研究
- 以患者为中心的护理
背景情况:
- 共享决策 (SDM) 越来越被认为在重症监护中至关重要.
- 它对重症患者及其代孕产妇的结果的影响需要全面评估.
研究的目的:
- 系统地审查和元分析SDM对重症患者的影响.
- 评估SDM对死亡率,重症监护室 (ICU) 和住院时间 (LOS) 的影响,以及患者和代孕者的心理健康结果.
主要方法:
- 按照PRISMA指南进行系统审查和元分析.
- 搜索了主要的数据库 (PubMed,EMBASE,Web of Science,Cochrane) 查询到2025年3月发表的随机对照试验 (RCT).
- 使用Cochrane工具评估偏差风险,并使用固定或随机效应模型合成数据.
主要成果:
- 分析了15个RCT,涉及3,678名ICU患者和2,777名代孕妇.
- 在SDM和全因死亡率之间没有发现显著的关联 (RR 1.05,95% CI 0.97-1.15)).
- 对于已死亡的患者,ICU LOS降低了 (SMD -0.15,p=0.02),但没有观察到对ICU或医院整体LOS的影响.
- SDM并没有改善代用精神健康结果 (抑郁,焦虑,PTSD) 或决策和沟通的质量.
结论:
- 共享决策可能会缩短死于重症病人的ICU停留时间,而不会影响死亡率或整体住院时间.
- 需要进一步研究文化定制的SDM干预措施,以满足各种患者和代孕需求.
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