The Critical Care Unit, University College London Hospitals NHS Foundation Trust UCLH, London NW1 2BU, UK.
Minerva Anestesiol. 2013 Aug;79(8):944-63. Epub 2013 Apr 5.
Patients may suffer extreme psychological reactions in intensive care units (ICU), and post-traumatic stress disorder (PTSD) after leaving hospital. Previous systematic reviews of studies up to 2007 found that the true prevalence of and consistent risk factors for PTSD after ICU were not established, due to methodological shortcomings of studies. Therefore we aimed to conduct a systematic review of observational studies of post-ICU PTSD from 2008-2012, and to compare them to 1997-2007 studies, with regard to quality, prevalence estimates and risk factors.
We used a pre-specified protocol, and systematic, explicit methods to identify, select and critically appraise studies. Studies in general ICU settings with mixed-diagnosis patients (N.>30) were included. Risk of bias was assessed, with lower-risk studies given greater weight. No quantitative synthesis was possible due to heterogeneity, therefore ranges of estimates and frequencies of risk factors were examined.
The review included 26 papers, 13 from 1997-2007 and 13 from 2008-2012. There were more high quality studies in the latter period. The range of prevalence estimates from high-quality studies was similar; 8% to 27% (1997-2007) and 9% to 27% (2008-2012). Clinical risk factors consistently identified over the two periods were use of benzodiazepines, duration of sedation and mechanical ventilation. Psychological risk factors include stress and fear experienced acutely in ICU, and frightening memories of the admission.
The quality and number of post-ICU PTSD studies has increased over time, and we can be more confident in the accumulated findings. Evidence from both periods suggests that up to 27% of ICU survivors suffer from PTSD. There is also increasing evidence that use of benzodiazepines and duration of sedation, along with fear, stress and delirium in the ICU are likely risk factors for subsequent PTSD.
患者在重症监护病房（ICU）中可能会遭受极端的心理反应，并且离开医院后可能会患上创伤后应激障碍（PTSD）。截至 2007 年的先前系统综述研究发现，由于研究方法上的缺陷，ICU 后 PTSD 的真实患病率和一致的危险因素尚未确定。因此，我们旨在对 2008-2012 年 ICU 后 PTSD 的观察性研究进行系统综述，并将其与 1997-2007 年的研究进行比较，从质量、患病率估计和危险因素方面进行比较。
我们使用预先确定的方案和系统、明确的方法来识别、选择和严格评估研究。纳入了普通 ICU 环境中混合诊断患者（N.>30）的研究。评估了偏倚风险，低风险研究给予更高的权重。由于异质性，无法进行定量综合，因此检查了估计值范围和危险因素的频率。
综述共纳入 26 篇论文，其中 13 篇来自 1997-2007 年，13 篇来自 2008-2012 年。后者时期有更多高质量的研究。高质量研究的患病率估计范围相似；1997-2007 年为 8%至 27%，2008-2012 年为 9%至 27%。两个时期一致确定的临床危险因素是使用苯二氮䓬类药物、镇静持续时间和机械通气。心理危险因素包括 ICU 中急性经历的压力和恐惧，以及入院时的可怕记忆。
随着时间的推移，ICU 后 PTSD 研究的质量和数量有所增加，我们对积累的发现更有信心。两个时期的证据均表明，多达 27%的 ICU 幸存者患有 PTSD。越来越多的证据表明，使用苯二氮䓬类药物和镇静持续时间，以及 ICU 中的恐惧、压力和谵妄，可能是随后 PTSD 的危险因素。
