Nelson J E, Meier D E, Oei E J, Nierman D M, Senzel R S, Manfredi P L, Davis S M, Morrison R S
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY 10029, USA.
Crit Care Med. 2001 Feb;29(2):277-82. doi: 10.1097/00003246-200102000-00010.
To characterize the symptom experience of a cohort of intensive care unit (ICU) patients at high risk for hospital death.
Prospective analysis of patients with a present or past diagnosis of cancer who were consecutively admitted to a medical ICU during an 8-month period.
Academic, university-affiliated, tertiary-care, urban medical center.
One hundred cancer patients treated in a medical ICU.
Assessment of symptoms.
Patients' self-reports of symptoms using the Edmonton Symptom Assessment Scale (ESAS), and ratings of pain or discomfort associated with ICU diagnostic/therapeutic procedures and of stress associated with conditions in the ICU.
Hospital mortality for the group was 56%. Fifty patients had the capacity to respond to the ESAS, among whom 100% provided symptom reports. Between 55% and 75% of ESAS responders reported experiencing pain, discomfort, anxiety, sleep disturbance, or unsatisfied hunger or thirst that they rated as moderate or severe, whereas depression and dyspnea at these levels were reported by approximately 40% and 33% of responders, respectively. Significant pain, discomfort, or both were associated with common ICU procedures, but most procedure-related symptoms were controlled adequately for a majority of patients. Inability to communicate, sleep disruption, and limitations on visiting were particularly stressful among ICU conditions studied.
Among critically ill cancer patients, multiple distressing symptoms were common in the ICU, often at significant levels of severity. Symptom assessment may suggest more effective strategies for symptom control and may direct decisions about appropriate use of ICU therapies.
描述一组有医院死亡高风险的重症监护病房（ICU）患者的症状体验。
对在8个月期间连续入住内科ICU且目前或既往诊断为癌症的患者进行前瞻性分析。
学术性、大学附属的三级城市医疗中心。
在内科ICU接受治疗的100例癌症患者。
症状评估。
使用埃德蒙顿症状评估量表（ESAS）对患者症状进行自我报告，以及对与ICU诊断/治疗操作相关的疼痛或不适和与ICU环境相关的压力进行评分。
该组患者的医院死亡率为56%。50例患者有能力对ESAS做出反应，其中100%提供了症状报告。在ESAS有反应的患者中，55%至75%报告经历过疼痛、不适、焦虑、睡眠障碍或未满足的饥饿或口渴，他们将这些症状评为中度或重度，而分别约40%和33%的有反应患者报告有这些程度的抑郁和呼吸困难。严重疼痛、不适或两者均与常见的ICU操作相关，但大多数与操作相关的症状在大多数患者中得到了充分控制。在所研究的ICU环境中，无法沟通、睡眠中断和探视受限尤其令人感到压力。
在危重症癌症患者中，多种令人痛苦的症状在ICU中很常见，且往往严重程度较高。症状评估可能提示更有效的症状控制策略，并可能指导关于ICU治疗适当使用的决策。
