School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA.
Nurs Res. 2011 May-Jun;60(3 Suppl):S50-7. doi: 10.1097/NNR.0b013e318216009c.
Mechanical ventilation is one of the most frequently used technological treatments in critical care units and induces great anxiety in patients.
Although mechanical ventilation and critical illness induce great anxiety and distress in hospitalized patients, little is known about anxiety ratings over the course of ventilatory support. Knowledge of anxiety ratings over time is needed to implement effective symptom management interventions. The purposes of this study were to describe anxiety ratings for a subgroup of mechanically ventilated patients over the duration of enrollment in a multisite clinical trial, to discern any pattern of change in anxiety ratings, to determine if anxiety decreases over time, and to explore the influence of sedative exposure on anxiety ratings.
Participants were 57 mechanically ventilated patients who were randomly assigned to the usual care group of a randomized controlled trial designed to assess the efficacy of music interventions on anxiety of mechanically ventilated patients in intensive care units. Anxiety ratings were obtained at study entry and daily for up to 30 days. A 100-mm visual analog scale was used to measure anxiety. Visual Analog Scale-Anxiety scores were plotted as a function of study time in days for each participant to discern possible patterns of change. A mixed-models analysis was performed to assess the nature and magnitude of change over time (slope) using 251 observations on 57 patients.
Results of the unconditional means model indicated that further modeling was appropriate. An autoregressive covariance structure with a random component for participant was chosen as the most appropriate covariance structure for modeling. An unconditional growth model indicated that the Visual Analog Scale-Anxiety ratings declined slowly over time: -.53 points per day (p = .09).
Anxiety is an individual patient experience that requires ongoing management with appropriate assessment and intervention over the duration of mechanical ventilatory support.
机械通气是重症监护病房中最常用的技术治疗方法之一，会给患者带来极大的焦虑。
尽管机械通气和重症会给住院患者带来极大的焦虑和痛苦，但人们对通气支持过程中的焦虑评分知之甚少。了解随时间推移的焦虑评分有助于实施有效的症状管理干预措施。本研究的目的是描述接受多部位临床试验机械通气患者亚组在整个入组期间的焦虑评分，辨别焦虑评分的变化模式，确定焦虑是否随时间减少，并探讨镇静药物暴露对焦虑评分的影响。
研究对象为 57 名接受机械通气的患者，他们被随机分配到一项随机对照试验的常规护理组，该试验旨在评估音乐干预对重症监护病房机械通气患者焦虑的疗效。在研究入组时和每天都进行焦虑评分。使用 100 毫米视觉模拟量表测量焦虑。为了辨别可能的变化模式，为每个参与者绘制研究时间（以天为单位）与视觉模拟量表-焦虑评分的函数图。对 57 名患者的 251 个观察值进行混合模型分析，以评估随时间变化的性质和幅度（斜率）。
无条件均值模型的结果表明，进一步建模是合适的。选择参与者的自回归协方差结构和随机分量作为建模的最合适协方差结构。无条件增长模型表明，视觉模拟量表-焦虑评分随时间缓慢下降：每天-0.53 分（p=0.09）。
焦虑是一种个体患者体验，需要在机械通气支持的整个过程中进行持续管理，包括适当的评估和干预。
