Kapfhammer Hans P, Rothenhäusler Hans B, Krauseneck Till, Stoll Christian, Schelling Gustav
Department of Psychiatry, Karl-Franzens-University, Graz, Austria.
Am J Psychiatry. 2004 Jan;161(1):45-52. doi: 10.1176/appi.ajp.161.1.45.
Intensive care often means exposure to physical and psychological stress, with long-lasting emotional sequelae for most patients. Psychiatric morbidity and negative effects on health-related quality of life were assessed in long-term survivors of acute respiratory distress syndrome.
Forty-six long-term survivors were enrolled in a psychiatric follow-up study. All patients had received standard, protocol-driven treatment during intensive care. The median follow-up time was 8 years after treatment. DSM-IV was used for psychiatric diagnosis. Psychological tests were performed to measure posttraumatic stress symptoms; depression; state anxiety; somatization; symptoms regarding concentration, attention, and short-term memory; social support; and health-related quality of life.
At time of discharge, 20 of the patients suffered from posttraumatic stress disorder (PTSD) and four from sub-PTSD. At follow-up, 11 patients continued to suffer from PTSD and eight from sub-PTSD. The patients with PTSD demonstrated a pronounced tendency for somatization and state anxiety. Among the groups with PTSD, sub-PTSD, and no PTSD, there were no statistically significant differences regarding social support and symptoms of cognitive dysfunction. Those with PTSD showed major impairments in some dimensions of health-related quality of life, whereas those without PTSD had scores that were in the range of the general population. Except for duration of stay on the intensive care unit, neither age, gender, sociodemographic variables, premorbid psychopathology, nor initial severity of illness discriminated between the groups.
Long-term survivors of acute respiratory distress syndrome seem to face a major risk of PTSD and major impairments in health-related quality of life in the long term.
重症监护通常意味着患者要承受身体和心理压力，大多数患者会出现长期的情绪后遗症。本研究评估了急性呼吸窘迫综合征长期幸存者的精神疾病发病率及其对健康相关生活质量的负面影响。
46名急性呼吸窘迫综合征长期幸存者参与了一项精神科随访研究。所有患者在重症监护期间均接受了标准化的、遵循方案的治疗。治疗后的中位随访时间为8年。采用《精神疾病诊断与统计手册》第四版（DSM-IV）进行精神科诊断。通过心理测试来测量创伤后应激症状、抑郁、状态焦虑、躯体化、注意力、集中力和短期记忆方面的症状、社会支持以及健康相关生活质量。
出院时，20名患者患有创伤后应激障碍（PTSD），4名患者患有亚创伤后应激障碍。随访时，11名患者仍患有创伤后应激障碍，8名患者患有亚创伤后应激障碍。患有创伤后应激障碍的患者表现出明显的躯体化和状态焦虑倾向。在患有创伤后应激障碍、亚创伤后应激障碍和无创伤后应激障碍的组间，社会支持和认知功能障碍症状方面无统计学显著差异。患有创伤后应激障碍的患者在健康相关生活质量的某些维度上存在严重损害，而无创伤后应激障碍的患者得分处于一般人群范围内。除了在重症监护病房的住院时间外，年龄、性别、社会人口统计学变量、病前精神病理学状况以及疾病初始严重程度在各组之间均无区分作用。
急性呼吸窘迫综合征的长期幸存者似乎长期面临创伤后应激障碍的重大风险以及健康相关生活质量的严重损害。
