Hauer Daniela, Weis Florian, Krauseneck Till, Vogeser Michael, Schelling Gustav, Roozendaal Benno
Department of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany.
Brain Res. 2009 Oct 13;1293:114-20. doi: 10.1016/j.brainres.2009.04.014. Epub 2009 Apr 17.
Survivors of the acute respiratory distress syndrome (ARDS) often report traumatic memories from the intensive care unit (ICU) and display a high incidence of post-traumatic stress disorder (PTSD). As it is known that subjects with PTSD often show sustained reductions in circulating cortisol concentrations, we examined the relationship between serum cortisol, traumatic memories and PTSD in patients after ARDS. We evaluated 33 long-term survivors of ARDS (7.5+/-2.9 years after discharge from the ICU) for pre-defined categories of traumatic memory from the ICU, hypothalamic-pituitary-adrenocortical axis reactivity to corticotropin and PTSD (by psychiatric interview). During evaluation, patients with multiple traumatic memories had significantly lower basal serum cortisol levels when compared to patients with no or only 1 category of traumatic memory, with no differences in peak cortisol levels after corticotropin stimulation between both subgroups. There was a significant negative correlation between basal cortisol levels and the number of traumatic memories present. PTSD symptom scores correlated with the number of traumatic memories but not with cortisol levels. These findings indicate that lower baseline cortisol levels in long-term survivors of ARDS are associated with an increased incidence of traumatic memories from the ICU, and that more traumatic memories are related to a higher incidence and intensity of PTSD symptoms.
急性呼吸窘迫综合征（ARDS）幸存者常报告在重症监护病房（ICU）有创伤性记忆，且创伤后应激障碍（PTSD）发病率很高。由于已知PTSD患者的循环皮质醇浓度常常持续降低，我们研究了ARDS患者血清皮质醇、创伤性记忆与PTSD之间的关系。我们评估了33名ARDS长期幸存者（从ICU出院后7.5±2.9年），针对来自ICU的预先定义的创伤性记忆类别、下丘脑 - 垂体 - 肾上腺皮质轴对促肾上腺皮质激素的反应性以及PTSD（通过精神科访谈）进行评估。在评估期间，与没有或仅有1类创伤性记忆的患者相比，有多种创伤性记忆的患者基础血清皮质醇水平显著更低，两个亚组在促肾上腺皮质激素刺激后皮质醇峰值水平无差异。基础皮质醇水平与存在的创伤性记忆数量之间存在显著负相关。PTSD症状评分与创伤性记忆数量相关，但与皮质醇水平无关。这些发现表明，ARDS长期幸存者较低的基线皮质醇水平与来自ICU的创伤性记忆发生率增加有关，且更多的创伤性记忆与更高的PTSD症状发生率和严重程度相关。
