不同探视制度对ICU患者ICU获得性感染及相关因素影响的Meta分析

目的比较非限制性探视制度和限制性探视制度对重症监护病房(ICU)患者谵妄、住院时间、获得性感染及患者焦虑抑郁的影响,探寻ICU最佳探视模式。方法检索Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文献数据库、万方数据库、中国知网全文数据库和维普数据库相关研究,截止日期2019年3月31日。由2名研究员对文献质量进行严格评价和资料提取,对符合纳入标准的文献进行Meta分析。结果研究共纳入18篇文献,其中13篇中文,5篇英文;8项研究为随机对照试验,10项研究为类实验研究。总样本量4 728例。将纳入研究按照研究设计和探视时间长短分亚组,森林图结果显示,与限制性探视相比较,非限制性探视制度能有效降低ICU患者谵妄发生率OR=0.19,95%CI(0.15,0.24),P0.001]、减少ICU患者焦虑MD=-1.60,95%CI(-1.67,-1.54),P0.001]和抑郁MD=-1.63,95%CI(-2.76,-0.49),P=0.003]等不良心理状态,并能有效提高ICU患者家属对ICU医护工作的满意度OR=3.56,95%CI(2.32,5.48),P0.1];同时,非限制性探视并不会增加ICU获得性感染的发生率OR=0.82,95%CI(0.55,1.21),P=0.31]、ICU病死率OR=0.61,95%CI(0.21,1.79),P=0.37]和住院时间MD=-0.40,95%CI(-1.29,0.50),P=0.39]。不考虑纳入研究设计,非限制性探视制度可降低ICU获得性感染的发生率OR=0.65,95%CI(0.51,0.82),P=0.004],并且探视时间越长ICU获得性感染的发生率反而越低OR=0.75,95%CI(0.61,0.91),P=0.004]。结论非限制性探视制度可以在不增加ICU获得性感染、住院时间和病死率的基础上,有效地降低ICU患者谵妄发生率,降低危重患者焦虑、抑郁等心理状态评分,提高ICU患者家属的满意度。

Meta-analysis on effect of different visiting policy on ICU-acquired infection and related factors in ICU patients

Objective To compare the effect of unrestrictive visiting policy(UVP) and restrictive visiting policy(RVP) on delirium, length of hospital stay, acquired infection, as well as anxiety and depression of patients in intensive care unit (ICU), explore the optimal visiting mode. Methods Relevant researches were retrieved from Cochrane Library, PubMed, Embase, Web of Science,Chinese Biomedical Literature Database, Wanfang Database, China National Knowledge Infrastructure(CNKI) and VIP Database,the deadline was March 31, 2019. Quality of literatures was strictly evaluated and data were extracted by two researchers, literatures which conformed to the inclusion criteria were performed Meta-analysis. Results A total of 18 literatures (13 Chinese and 5 English) were included in this study, 8 were randomized controlled trial (RCT) studies and 10 were quasi-experimental studies, 4 728 patients were included. The included studies were divided into subgroups according to study design and length of visiting, forest plot result showed that compared with RVP, UVP could effectively reduce the incidence of delirium in ICU patients (OR=0.19, 95% CI0.15, 0.24], P<0.001), reduce ICU patients'' anxiety (MD=-1.60, 95% CI-1.67, -1.54], P<0.001) and depression (MD=-1.63, 95% CI-2.76, -0.49], P=0.003), as well as effectively improve patients'' relatives'' satisfaction to health care workers in ICU (OR=3.56, 95% CI2.32, 5.48], P<0.1); meanwhile, UVP didn''t increase the incidence of ICU-acquired infection (OR=0.82, 95% CI0.55, 1.21], P=0.31), ICU mortality (OR=0.61, 95% CI0.21, 1.79], P=0.37), and length of hospital stay(MD=-0.40, 95% CI-1.29, 0.50], P=0.39). In addition, without considering the study design, UVP could reduce the incidence of ICU-acquired infection (OR=0.65, 95% CI0.51, 0.82], P=0.004), the longer the visiting duration, the lower the incidence of ICU-acquired infection (OR=0.75, 95% CI0.61, 0.91], P=0.004). Conclusion UVP does not increase the incidence of ICU-acquired infection, length of hospital stay and mortality, but can effectively decrease the incidence of ICU patients'' delirium, reduce critically ill patients'' anxiety and depression, and improve ICU patients'' relatives'' satisfaction.