Gamper Gunnar, Willeit Matthaeus, Sterz Fritz, Herkner Harald, Zoufaly Alexander, Hornik Kurt, Havel Christof, Laggner A N
University Clinic of Emergency Medicine, University of Vienna, Austria.
Crit Care Med. 2004 Feb;32(2):378-83. doi: 10.1097/01.CCM.0000108880.97967.C0.
Cardiac arrest is possibly one of the most traumatizing conditions for patients, but to date, its influence on psychic morbidity remains unknown. Posttraumatic stress disorder is a unique symptom configuration after an extreme event consisting of intrusion re-experiencing, avoidance and numbness, and hyperarousal symptoms. We studied a) the prevalence of posttraumatic stress disorder (PTSD) in long term survivors of cardiac arrest; b) the role of specific stress factors related to cardiac arrest for the development of PTSD; and c) the influence of sedation and analgesia during or after cardiac arrest on the occurrence of PTSD.
Prospective, cohort study.
University teaching hospital.
Analysis was performed in cardiac arrest survivors who were discharged with favorable neurologic outcome during an 8-yr period (1991-1999).
All patients received the Davidson Trauma Score for the assessment of PTSD and a modified German version of the EuroQol questionnaire for assessment of quality of life. Cardiac arrest circumstances and administration of sedation and analgesia were assessed.
Of 1,630 initially resuscitated patients, 270 patients were discharged with good neurologic outcome. A total of 226 patients were contacted, and 143 patients (63% of all eligible patients) completed the study. Mean time from cardiac arrest to follow up was 45 months (range, 24-66). Thirty-nine patients (27%; 95% confidence interval, 21% to 35%) had a Davidson Trauma Score >40 and fulfilled criteria for PTSD. Patients with PTSD had a significantly lower quality of life. The only independent risk factor for the development of PTSD was younger age. There was no difference between patients with or without PTSD regarding the use of sedation and analgesia during or after cardiac arrest.
The prevalence of PTSD in cardiac arrest survivors is high. Besides younger age, neither clinical factors nor the use of sedation and analgesia were associated with development of PTSD.
心脏骤停可能是患者最具创伤性的病症之一，但迄今为止，其对精神疾病的影响仍不明确。创伤后应激障碍是极端事件后出现的一种独特症状组合，包括侵入性再体验、回避和麻木以及过度警觉症状。我们研究了：a）心脏骤停长期幸存者中创伤后应激障碍（PTSD）的患病率；b）与心脏骤停相关的特定应激因素在PTSD发生中的作用；c）心脏骤停期间或之后的镇静和镇痛对PTSD发生的影响。
前瞻性队列研究。
大学教学医院。
对1991年至1999年8年间出院时神经功能良好的心脏骤停幸存者进行分析。
所有患者均接受用于评估PTSD的戴维森创伤评分以及用于评估生活质量的改良德文版欧洲生活质量调查问卷。评估心脏骤停情况以及镇静和镇痛的使用情况。
在最初复苏的1630例患者中，270例患者出院时神经功能良好。共联系了226例患者，143例患者（占所有符合条件患者的63%）完成了研究。从心脏骤停到随访的平均时间为45个月（范围24 -
66个月）。39例患者（27%；95%置信区间，21%至35%）的戴维森创伤评分>40，符合PTSD标准。PTSD患者的生活质量显著较低。PTSD发生的唯一独立危险因素是年龄较小。在心脏骤停期间或之后使用镇静和镇痛方面，有PTSD和无PTSD的患者之间没有差异。
心脏骤停幸存者中PTSD的患病率较高。除年龄较小外，临床因素以及镇静和镇痛的使用均与PTSD的发生无关。
