Abstract: Background　Sleep problem has become a common health issue in critically ill patients.Poor-quality sleep not only increases the level of anxiety in such patients，but also may lead to delirium and other cognitive impairments.Although pharmacologic treatment can improve sleep quality，it also has a series of side effects.So，relieving the conditions via stimulating sensory perception and creating relaxing effects by nonpharmacological interventions is becoming increasingly important.However，whether use of earplugs and eye masks can improve the quality of sleep and reduce the incidence of delirium in this population，the evidence is still insufficient.Objective　To evaluate the effectiveness of earplugs and eye masks on the incidence of delirium and sleep quality in critically ill patients.Methods　We searched the databases of PubMed，Medline，CINAHL，Cochrane Library，CNKI，Wanfang Data Knowledge Service Platform and CBM from inception to March 2018 for articles regarding the improvement of sleep quality in critically ill patients by use of earplugs and/or eye masks.Data extraction and quality assessment were conducted on the eligible articles.Meta-analysis was carried out with RevMan 5.3 software.Results　Twenty articles with a total of 1 364 patients were finally included.The results of meta-analysis showed that the use of earplugs and eye masks significantly reduced the incidence of delirium 〔RR=0.52，95%CI（0.41，0.66），P<0.000 01〕.PSQI score in the experimental group was lower than that of control group 〔MD=-4.63，95%CI（-6.82，-2.43），P<0.000 1〕.The sleep effectiveness score in the experimental group was higher than that of control group 〔SMD=1.54，95%CI（0.48，2.61），P=0.005〕.The sleep disturbance score in the experimental group was higher than that of control group 〔SMD=1.36，95%CI（0.55，2.17），P=0.001〕.There was no significant difference in sleep supplementation score between two groups 〔SMD=1.25，95%CI（-0.34，2.83），P=0.12〕.Sleep duration did not differ significantly between two groups 〔SMD=1.11，95%CI（-0.43，2.65），P=0.16〕.Distribution of sleep duration showed no obvious difference between two groups 〔RR=1.00，95%CI（0.76，1.31），P=1.00〕.Conclusion　Earplugs and eye masks are effective interventions to reduce the incidence of delirium and improve sleep quality of critically ill patients.But it is not certain whether they could improve sleep duration，too.

Key words: Delirium；Ear protective device；Eye mask, Intensive care units；Sleep quality；Meta-analysis

摘要： 背景　睡眠问题已成为危重患者普遍存在的问题。低质量的睡眠不仅会增加危重患者的焦虑，还可能导致谵妄等认知功能障碍。药物治疗虽能促进患者睡眠，但也产生一系列的不良反应。因此，采用非药物干预刺激感官知觉和产生放松效果缓解疾病越来越重要。耳塞和眼罩能否改善危重患者的睡眠质量、减少谵妄尚无充足证据支持。目的　评价耳塞和眼罩对重症监护室（ICU）患者谵妄和睡眠质量的影响。方法　计算机检索PubMed、Medline、CINAHL、Cochrane Library、中国知网、万方数据知识服务平台、中国生物医学文献服务系统中ICU患者睡眠相关的文献，试验组给予耳塞和/或眼罩，对照组为空白对照或仅给予常规护理，检索时间为建库至2018年3月。对纳入文献进行质量评价和数据提取，采用RevMan 5.3软件进行Meta分析。结果　共纳入20篇文献，包括1 364例患者。Meta分析结果显示，试验组谵妄发生率低于对照组〔相对危险度（RR）=0.52，95%CI（0.41，0.66），P<0.000 01〕。试验组匹兹堡睡眠质量量表（PSQI）评分低于对照组〔均数差（MD）=-4.63，95%CI（-6.82，-2.43），P<0.000 1〕。试验组睡眠有效性评分高于对照组〔标准化均数差（SMD）=1.54，95%CI（0.48，2.61），P=0.005〕；试验组睡眠障碍评分高于对照组〔SMD=1.36，95%CI（0.55，2.17），P=0.001〕；两组睡眠补充评分比较，差异无统计学意义〔SMD=1.25，95%CI（-0.34，2.83），P=0.12〕；两组睡眠时长比较，差异无统计学意义〔SMD=1.11，95%CI（-0.43，2.65），P=0.16〕；两组睡眠时长的分布比较，差异无统计学意义〔RR=1.00，95%CI（0.76，1.31），P=1.00〕。结论　耳塞和眼罩可减少ICU患者谵妄发生，并改善其睡眠质量，但对睡眠时长的效果尚不明确。

关键词: 谵妄, 耳防护器, 眼罩, 重症监护病房, 睡眠质量, Meta分析