重症监护病房不限制探视可减少心血管并发症

Reduced Cardiocirculatory Complications With Unrestrictive Visiting Policy in an Intensive Care Unit
Results From a Pilot, Randomized Trial
Background— Observational studies suggest that open visiting policies are preferred by most patients and visitors in intensive care units (ICUs), but no randomized trial has compared the safety and health outcomes of unrestrictive (UVP) and restrictive (RVP) visiting policies. The aim of this pilot, randomized trial was to compare the complications associated with UVP (single visitor with frequency and duration chosen by patient) and RVP (single visitor for 30 minutes twice a day).
Methods and Results— Two-month sequences of the 2 visiting policies were randomly alternated for 2 years in a 6-bed ICU, with 226 patients enrolled (RVP/UVP, n=115/111). Environmental microbial contamination, septic and cardiovascular complications, emotional profile, and stress hormones response were systematically assessed. Patients admitted during the randomly scheduled periods of UVP received more frequent (3.2±0.2 versus 2.0±0.0 visits per day, mean±SEM) and longer (2.6±0.2 versus 1.0±0.0 h/d) visits (P<0.001 for both comparisons). Despite significantly higher environmental microbial contamination during the UVP periods, septic complications were similar in the 2 periods. The risk of cardiocirculatory complications was 2-fold (odds ratio 2.0; 95% CI, 1.1 to 3.5; P=0.03) in the RVP periods, which were also associated with a nonsignificantly higher mortality rate (5.2% versus 1.8%; P=0.28). The UVP was associated with a greater reduction in anxiety score and a significantly lower increase in thyroid stimulating hormone from admission to discharge.
Conclusions— Despite greater environmental microbial contamination, liberalizing visiting hours in ICUs does not increase septic complications, whereas it might reduce cardiovascular complications, possibly through reduced anxiety and more favorable hormonal profile.

重症监护病房不限制探视可减少心血管并发症

背景：重症监护病房（ICUs）开放探视受到患者和探视者的欢迎，但是没有相关随机试验来比较限制探视（RVP）和开放探视（UVP）在安全性和健康方面的差异。这项小规模随机试验的目的是比较UVP和RVP患者的并发症。UVP定义为单人探视频率时间均无限制，RVP定义为单人探视，一次30分钟，每天2次。

方法和结果：我们在一个6张病床的ICU进行了2年的观察，随机交替两种探视方式，每次持续2个月，共入组226例患者（RVP/UVP＝115/111）。评估环境微生物污染，败血症和心血管并发症，情绪波动情况和应激性内分泌改变。UVP患者比RVP患者探视次数更多（3.2±0.2比2.0±0.0次每天，P＜0.001），时间更长（2.6±0.2比1.0±0.0小时每天，P＜0.001）。尽管UVP方式环境微生物污染明显多些，但两组的败血症发生率类似。RVP组心血管并发症的危险性增高（OR 2.0，95%CI 1.1～3.5，P＝0.03），并伴有不显著的死亡率增高（5.2%比1.8%，P＝0.28）。UVP组患者明显焦虑情况减少，入院到出院期间促甲状腺激素分泌增加明显较少。

结论：尽管环境污染增加，开放探视并未增加败血症发生，反而可以减少心血管并发症，这可能是因为减少焦虑和促进某些有利激素分泌。