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危重症需综合重症监护后的创伤后应激障碍

Post-traumatic stress disorder after critical illness requiring general intensive care.

作者信息

Cuthbertson Brian H, Hull Alastair, Strachan Mary, Scott Judith

机构信息

Anaesthesia and Intensive Care, Medicine and Therapeutics, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, Scotland, UK.

出版信息

Intensive Care Med. 2004 Mar;30(3):450-5. doi: 10.1007/s00134-003-2004-8. Epub 2003 Sep 5.

Abstract

OBJECTIVE

To determine the incidence and severity of symptoms related to the diagnosis of post-traumatic stress disorder (PTSD) in a cohort of general ICU patients.

DESIGN

A prospective cohort study 3 months after general ICU discharge.

SETTING

A general ICU in a teaching hospital in northern Scotland.

PATIENTS AND PARTICIPANTS

Seventy-eight ICU survivors of general ICU.

INTERVENTIONS

Patients were contacted 3 months after ICU discharge and asked to complete a telephone assessment of the Davidson Trauma Scale.

MEASUREMENTS AND RESULTS

The median score was 8, with 22% recording a score of at least 27 and 14% meeting the full diagnostic criteria for PTSD. The overall score was not correlated with sex, ICU length of stay, or APACHE II score but was inversely correlated with age and directly correlated with length of mechanical ventilation. The overall score was also related to the patient reporting having visited a GP or a mental health professional for psychological distress previous to ICU.

CONCLUSIONS

We found a high incidence of symptoms consistent with PTSD 3 months after ICU discharge in this general ICU cohort. This was associated with younger patients and those who visited their GP or a mental health professional complaining of psychological symptoms. Further research and a greater liaison between ICU staff and family practitioners and mental health practitioners is required to better identify individuals at risk and reduce psychological morbidity in this group.

摘要

目的

确定一组普通重症监护病房(ICU)患者中与创伤后应激障碍(PTSD)诊断相关症状的发生率和严重程度。

设计

在普通ICU出院3个月后进行的前瞻性队列研究。

地点

苏格兰北部一家教学医院的普通ICU。

患者和参与者

78名普通ICU的幸存者。

干预措施

在ICU出院3个月后联系患者,并要求他们完成戴维森创伤量表的电话评估。

测量和结果

中位数分数为8分,22%的患者分数至少为27分,14%的患者符合PTSD的完整诊断标准。总分与性别、ICU住院时间或急性生理与慢性健康状况评分系统(APACHE II)评分无关,但与年龄呈负相关,与机械通气时间呈正相关。总分还与患者报告在入住ICU之前因心理困扰而去看全科医生(GP)或心理健康专业人员有关。

结论

我们发现,在这个普通ICU队列中,ICU出院3个月后出现与PTSD一致症状的发生率很高。这与年轻患者以及那些因心理症状而去看全科医生或心理健康专业人员的患者有关。需要进一步研究,并加强ICU工作人员与家庭医生和心理健康从业者之间的联系,以更好地识别有风险的个体,并降低该群体的心理发病率。

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