重症监护病房高危死亡患者的症状。
Symptoms experienced by intensive care unit patients at high risk of dying.
机构信息
University of California, San Francisco, CA, USA.
出版信息
Crit Care Med. 2010 Nov;38(11):2155-60. doi: 10.1097/CCM.0b013e3181f267ee.
OBJECTIVE
To provide a focused, detailed assessment of the symptom experiences of intensive care unit patients at high risk of dying and to evaluate the relationship between delirium and patients' symptom reports.
DESIGN
Prospective, observational study of patients' symptoms.
SETTING
Two intensive care units in a tertiary medical center in the western United States.
PATIENTS
One hundred seventy-one intensive care unit patients at high risk of dying.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Patients were interviewed every other day for up to 14 days. Patients rated the presence, intensity (1 = mild; 2 = moderate; 3 = severe), and distress (1 = not very distressing; 2 = moderately distressing; 3 = very distressing) of ten symptoms (that is, pain, tired, short of breath, restless, anxious, sad, hungry, scared, thirsty, confused). The Confusion Assessment Method-Intensive Care Unit was used to ascertain the presence of delirium. A total of 405 symptom assessments were completed by 171 patients. Patients' average age was 58 ± 15 yrs; 64% were males. Patients were mechanically ventilated during 34% of the 405 assessments, and 22% died in the hospital. Symptom prevalence ranged from 75% (tired) to 27% (confused). Thirst was moderately intense, and shortness of breath, scared, confusion, and pain were moderately distressful. Delirium was found in 34.2% of the 152 patients who could be evaluated. Delirious patients were more acutely ill and received significantly higher doses of opioids. Delirious patients were significantly more likely to report feeling confused (43% vs. 22%, p = .004) and sad (46% vs. 31%, p = .04) and less likely to report being tired (57% vs. 77%, p = .006) than nondelirious patients.
CONCLUSIONS
Study findings suggest that unrelieved and distressing symptoms are present for the majority of intensive care unit patients, including those with delirium. Symptom assessment in high-risk intensive care unit patients may lead to more focused interventions to avoid or minimize unnecessary suffering.
目的
对高危死亡重症监护病房患者的症状体验进行重点、详细评估，并评估谵妄与患者症状报告之间的关系。
设计
对患者症状进行前瞻性、观察性研究。
地点
美国西部一家三级医疗中心的两个重症监护病房。
患者
171 名高危死亡重症监护病房患者。
干预措施
无。
测量和主要结果
患者每隔一天接受一次访谈，最多持续 14 天。患者评估了十种症状（即疼痛、疲倦、呼吸急促、不安、焦虑、悲伤、饥饿、恐惧、口渴、困惑）的存在、强度（1=轻度；2=中度；3=重度）和困扰程度（1=不太困扰；2=中度困扰；3=非常困扰）。使用重症监护病房意识模糊评估法确定谵妄的存在。共有 171 名患者完成了 405 次症状评估。患者的平均年龄为 58 ± 15 岁；64%为男性。在 405 次评估中有 34%的患者接受机械通气，22%的患者在医院死亡。症状的患病率从 75%（疲倦）到 27%（困惑）不等。口渴的程度为中度，呼吸急促、恐惧、意识混乱和疼痛的程度为中度困扰。在可评估的 152 名患者中，有 34.2%的患者存在谵妄。谵妄患者的病情更为急性，且接受了更高剂量的阿片类药物。与非谵妄患者相比，谵妄患者更有可能感到困惑（43%比 22%，p=.004）和悲伤（46%比 31%，p=.04），而不太可能感到疲倦（57%比 77%，p=.006）。
结论
研究结果表明，大多数重症监护病房患者（包括谵妄患者）存在未得到缓解且令人痛苦的症状。对高危重症监护病房患者进行症状评估可能会导致更有针对性的干预措施，以避免或最小化不必要的痛苦。
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