成人ICU清醒患者非限制性探视管理的最佳证据总结

Summary of the Best Evidence for Unrestricted Visitation Management of Awake Patients in the Adult ICU

摘要: 目的：检索并总结非限制性探视策略在成人ICU清醒患者中应用的最佳证据，为临床规范化管理提供循证依据。方法：按照“5S”证据模型，系统检索国内外计算机决策支持系统、指南网、数据库及相关学会网站，纳入的文献类型包括临床决策、证据总结、循证实践、指南、专家共识、系统评价、随机对照实验，检索时限为建库至2024年11月15日。由2名研究者独立进行文献质量评价和证据提取，研究团队对证据进行归纳整合。结果：最终纳入16篇文献，其中临床决策1篇，指南1篇，标准1篇，最佳证据总结1篇，循证实践1篇，专家共识2篇，系统评价3篇，原始研究6篇，形成探视时间、探视人员、患者隐私保护、感染控制与个人防护、特殊时期的探视、探视相关人员培训、环境管理7个方面共总结22条最佳证据。结论：该研究总结了在成人ICU清醒患者中实施非限制性探视策略的最佳证据，建议医护人员根据患者、家属、医护人员及医疗机构等情况制定以患者为中心的非限制性探视管理政策，以改善ICU清醒患者的住院体验和临床结局。

Abstract: Objective: To retrieve and summarize the best evidence on the use of unrestricted visiting strategies in adult ICU awake patients, and to provide an evidence-based basis for standardized clinical management. Methods: In accordance with the “5S” evidence model, we systematically searched domestic and international computerized decision support systems, guideline networks, databases, and websites of related societies, and the types of literature included clinical decision-making, evidence summaries, evidence-based practices, guidelines, expert consensus, systematic evaluations, and randomized controlled trials, with a timeframe for searching from the establishment of the database to November 2024. Literature quality assessment and evidence extraction were performed independently by 2 investigators, and the research team summarized and integrated the evidence. Result: Sixteen articles were finally included in the literature, including one clinical decision, one guideline, one standard, one best evidence summary, one evidence-based practice, two expert consensus, three systematic evaluations, and six original studies, which resulted in the best evidence in a total of 22 summaries in seven areas: visiting hours, visitors, patient privacy protection, infection control and personal protection, visiting during special times, training of visiting-related personnel, and environmental management. Conclusion: This study summarizes the best evidence for the implementation of unrestricted visitation strategies in adult ICU awake patients, and recommends that healthcare professionals develop a patient-centered unrestricted visitation management policy based on the patient, family, healthcare staff, and healthcare facility to improve the hospital experience and clinical outcomes of ICU awake patients.