Dowdy David W, Eid Mark P, Dennison Cheryl R, Mendez-Tellez Pedro A, Herridge Margaret S, Guallar Eliseo, Pronovost Peter J, Needham Dale M
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Intensive Care Med. 2006 Aug;32(8):1115-24. doi: 10.1007/s00134-006-0217-3. Epub 2006 Jun 17.
To summarize long-term quality of life (QOL) and the degree of variation in QOL estimates across studies of acute respiratory distress (ARDS) survivors.
A systematic review of studies evaluating QOL in ARDS survivors was conducted. Medline, EMBASE, CINAHL, pre-CINAHL, and the Cochrane Library were searched, and reference lists from relevant articles were evaluated. Two authors independently selected studies reporting QOL in adult survivors of ARDS or acute lung injury at least 30 days after intensive care unit discharge and extracted data on study design, patient characteristics, methods, and results.
Thirteen independent observational studies (557 patients) met inclusion criteria. Eight of these studies used eight different QOL instruments, allowing only qualitative synthesis of results. The five remaining studies (330 patients) measured QOL using the Medical Outcomes Study 36-Item Short Form survey (SF-36). Mean QOL scores were similar across these studies, falling within a range of 20 points for all domains. Pooled domain-specific QOL scores in ARDS survivors 6 months or later after discharge ranged from 45 (role physical) to 66 (social functioning), or 15-26 points lower than population norms, in all domains except mental health (11 points) and role physical (39 points). Corresponding confidence intervals were no wider than +/-9 points. Six studies all found stable or improved QOL over time, but only one found significant improvement beyond 6 months after discharge.
ARDS survivors in different clinical settings experience similar decrements in QOL. The precise magnitude of these decrements helps clarify the long-term prognosis for ARDS survivors.
总结急性呼吸窘迫综合征（ARDS）幸存者的长期生活质量（QOL）以及各研究中QOL评估的变异程度。
对评估ARDS幸存者QOL的研究进行系统综述。检索了Medline、EMBASE、CINAHL、CINAHL之前的数据库以及Cochrane图书馆，并评估了相关文章的参考文献列表。两位作者独立选择报告成人ARDS或急性肺损伤幸存者在重症监护病房出院至少30天后QOL的研究，并提取有关研究设计、患者特征、方法和结果的数据。
13项独立观察性研究（557例患者）符合纳入标准。其中8项研究使用了8种不同的QOL工具，仅允许对结果进行定性综合分析。其余5项研究（330例患者）使用医学结局研究36项简短问卷（SF-36）测量QOL。这些研究中的平均QOL得分相似，所有领域的得分范围在20分以内。出院6个月或更久后的ARDS幸存者特定领域QOL合并得分在45（身体功能）至66（社会功能）之间，除心理健康（11分）和身体功能（39分）外，所有领域均比人群常模低15 - 26分。相应的置信区间不超过±9分。6项研究均发现QOL随时间稳定或改善，但只有1项研究发现出院6个月后有显著改善。
不同临床环境中的ARDS幸存者在QOL方面有相似程度的下降。这些下降的确切幅度有助于阐明ARDS幸存者的长期预后。
