Jones Christina, Skirrow Paul, Griffiths Richard D, Humphris Gerald H, Ingleby Sarah, Eddleston Jane, Waldmann Carl, Gager Melanie
Department of Medicine, University of Liverpool, and the Intensive Care Unit, Whiston Hospital, Prescot, UK.
Crit Care Med. 2003 Oct;31(10):2456-61. doi: 10.1097/01.CCM.0000089938.56725.33.
To evaluate the effectiveness of a rehabilitation program following critical illness to aid physical and psychological recovery.
Randomized controlled trial, blind at follow-up with final assessment at 6 months.
Two district general hospitals and one teaching hospital.
Patients were 126 consecutively admitted intensive care patients meeting the inclusion criteria.
Control patients received ward visits, three telephone calls at home, and clinic appointments at 8 wks and 6 months. Intervention patients received the same plus a 6-wk self-help rehabilitation manual.
We measured levels of depression and anxiety (Hospital Anxiety and Depression Scale), phobic symptoms (Fear Index), posttraumatic stress disorder (PTSD)-related symptoms (Impact of Events Scale), and scores on the Short-Form Health Survey physical dimension 8 wks and 6 months after intensive care unit (ICU) treatment. Memory for ICU was assessed at 2 wks post-ICU discharge using the ICU Memory Tool.The intervention group improved, compared with the control patients, on the Short-Form Health Survey physical function scores at 8 wks and 6 months (p =.006), and there was a trend to a lower rate of depression at 8 wks (12% vs. 25%). However, there were no differences in levels of anxiety and PTSD-related symptoms between the groups. The presence of delusional memories was correlated significantly with both anxiety and Impact of Events Scale scores.
A self-help rehabilitation manual is effective in aiding physical recovery and reducing depression. However, in those patients recalling delusional memories from the ICU, further psychological care may be needed to reduce the incidence of anxiety and PTSD-related symptoms.
评估危重症后康复计划对身体和心理恢复的有效性。
随机对照试验，随访时设盲，6个月时进行最终评估。
两家地区综合医院和一家教学医院。
126名连续入院且符合纳入标准的重症监护患者。
对照组患者接受病房探访、三次家庭电话随访以及8周和6个月时的门诊预约。干预组患者除上述措施外，还收到一本为期6周的自助康复手册。
我们在重症监护病房（ICU）治疗后8周和6个月时，测量了抑郁和焦虑水平（医院焦虑抑郁量表）、恐惧症状（恐惧指数）、创伤后应激障碍（PTSD）相关症状（事件影响量表）以及简短健康调查问卷身体维度得分。使用ICU记忆工具在ICU出院后2周评估对ICU的记忆。与对照组患者相比，干预组在8周和6个月时的简短健康调查问卷身体功能得分有所改善（p = 0.006），且在8周时抑郁发生率有降低趋势（12%对25%）。然而，两组在焦虑水平和PTSD相关症状方面没有差异。妄想记忆的存在与焦虑和事件影响量表得分均显著相关。
一本自助康复手册有助于身体恢复并减轻抑郁。然而，对于那些回忆起ICU中妄想记忆的患者，可能需要进一步的心理护理以降低焦虑和PTSD相关症状的发生率。
