成人呼吸窘迫综合征认知结局研究：急性肺损伤幸存者的长期神经心理学功能。
The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury.
机构信息
Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, 836 W. Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA.
出版信息
Am J Respir Crit Care Med. 2012 Jun 15;185(12):1307-15. doi: 10.1164/rccm.201111-2025OC. Epub 2012 Apr 6.
RATIONALE
Cognitive and psychiatric morbidity is common and potentially modifiable after acute lung injury (ALI). However, practical measures of neuropsychological function for use in multicenter trials are lacking.
OBJECTIVES
To determine whether a validated telephone-based neuropsychological test battery is feasible in a multicenter trial. To determine the frequency and risk factors for long-term neuropsychological impairment.
METHODS
As an adjunct study to the Acute Respiratory Distress Syndrome Clinical Trials Network Fluid and Catheter Treatment Trial, we assessed neuropsychological function at 2 and 12 months post-hospital discharge.
MEASUREMENTS AND MAIN RESULTS
Of 406 eligible survivors, we approached 261 to participate and 213 consented. We tested 122 subjects at least once, including 102 subjects at 12 months. Memory, verbal fluency, and executive function were impaired in 13% (12 of 92), 16% (15 of 96), and 49% (37 of 76) of long-term survivors. Long-term cognitive impairment was present in 41 of the 75 (55%) survivors who completed cognitive testing. Depression, post-traumatic stress disorder, or anxiety was present in 36% (37 of 102), 39% (40 of 102), and 62% (63 of 102) of long-term survivors. Enrollment in a conservative fluid-management strategy (P = 0.005) was associated with cognitive impairment and lower partial pressure of arterial oxygen during the trial was associated with cognitive (P = 0.02) and psychiatric impairment (P = 0.02).
CONCLUSIONS
Neuropsychological function can be assessed by telephone in a multicenter trial. Long-term neuropsychological impairment is common in survivors of ALI. Hypoxemia is a risk factor for long-term neuropsychological impairment. Fluid management strategy is a potential risk factor for long-term cognitive impairment; however, given the select population studied and an unclear mechanism, this finding requires confirmation.
背景
认知和精神障碍在急性肺损伤（ALI）后很常见，且具有潜在可改变性。然而，在多中心试验中，缺乏实用的神经心理学功能测量方法。
目的
确定验证后的基于电话的神经心理测试组合在多中心试验中是否可行。确定长期神经心理损伤的频率和危险因素。
方法
作为急性呼吸窘迫综合征临床试验网络液体和导管治疗试验的辅助研究，我们在出院后 2 个月和 12 个月评估神经心理学功能。
测量和主要结果
在 406 名符合条件的幸存者中，我们接触了 261 名参与者，其中 213 名同意参加。我们至少测试了 122 名受试者，包括 102 名在 12 个月时的受试者。记忆、语言流畅性和执行功能在 13%（92 名中的 12 名）、16%（96 名中的 15 名）和 49%（76 名中的 37 名）的长期幸存者中受损。在完成认知测试的 75 名幸存者中有 41 名（55%）存在长期认知障碍。36%（102 名中的 37 名）、39%（102 名中的 40 名）和 62%（102 名中的 63 名）的长期幸存者存在创伤后应激障碍或焦虑症。纳入保守液体管理策略（P=0.005）与认知障碍相关，试验期间较低的动脉血氧分压与认知（P=0.02）和精神障碍（P=0.02）相关。
结论
多中心试验中可以通过电话评估神经心理学功能。ALI 幸存者中常见长期神经心理障碍。低氧血症是长期神经心理障碍的危险因素。液体管理策略是长期认知障碍的潜在危险因素；然而，鉴于研究的选择性人群和不清楚的机制，这一发现需要进一步证实。
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