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镇静、谵妄与创伤后应激障碍之间的关联及其对重症监护病房出院后生活质量和记忆的影响。

Associations between sedation, delirium and post-traumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit.

作者信息

Svenningsen Helle

机构信息

Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.

出版信息

Dan Med J. 2013 Apr;60(4):B4630.


DOI:
PMID:23651729
Abstract

UNLABELLED: In the intensive care units (ICUs) sedation strategies have changed in the past decade towards less sedation and daily wake-up calls. Recent studies indicate that no sedation (after intubation) is most beneficial for patients. A smaller number of these patients have been assessed for post-traumatic stress disorder (PTSD) after ICU discharge, but none of them were assessed for delirium while in the ICU. In other studies, delirium in the ICU is described as distressing for the patients and increasing morbidity, i.e. dementia after discharge and mortality. The associations between sedation, delirium, and PTSD have not previous been described. The aim of this PhD study was to investigate: 1) how sedation is associated with delirium in the ICU, 2) the consequences of delirium in relation to PTSD, anxiety, and depression, 3) the consequences of delirium for the patients' memories from ICU and the health-related quality of life after discharge. In a prospective observation study with patients admitted a minimum of 48 hours to the ICUs in Aarhus or Hillerød, we included all patients aged > 17 years. Non-Danish-speaking, patients transferred from other ICUs and patients with brain injury that made delirium-assessment impossible were excluded. Patients were interviewed face-to-face after 1 week, and at 2 months and 6 months by telephone using six different questionnaires. Among 3,066 patients admitted to the ICUs, 942 fulfilled the inclusion criteria. Primarily due to the inability to test for delirium, 302 patients were later excluded. Of the remaining 640 patients, 65% were delirious on 1 or more days. Fluctuations in sedation levels increased the risk of delirium statistically significantly with or without adjustments for age, gender, severity of illness, surgical/medical patient, or ICU site. After 2 months vs. 6 months, 297 patients vs. 248 patients were interviewed. PTSD was found in 7% vs. 5%, anxiety in 6% vs. 4%, and depression in 10% at both interviews. Delirium had no association with any of the psychometric results. Memories of delusion and memories of feelings were statistically significantly associated with delirium and with the psychometric outcomes, whereas memories of facts had no association with the psychometric outcomes. Health-related quality of life (SF-36) was statistically significantly decreased in most of the domains if patients had PTSD, anxiety, or depression but was not associated with delirium or the type of memories. CONCLUSION: Fluctuations in the level of sedation of patients in the ICU increased the incidence of delirium, but the delirium did not affect the risk of PTSD, anxiety, or depression. These were, however, affected by the type of memories the patients had. Health-related quality of life (SF-36) was decreased if patients had PTSD, anxiety, or depression but was unaffected by memories of the ICU and the presence of delirium while in the ICU.

摘要

未标注:在过去十年中,重症监护病房(ICU)的镇静策略已朝着减少镇静和每日唤醒的方向转变。最近的研究表明,(插管后)不进行镇静对患者最为有益。这些患者中较少有人在ICU出院后接受创伤后应激障碍(PTSD)评估,但在ICU期间均未对他们进行谵妄评估。在其他研究中,ICU中的谵妄被描述为令患者痛苦并增加发病率,即出院后出现痴呆和死亡率。镇静、谵妄和PTSD之间的关联此前尚未有描述。本博士研究的目的是调查:1)ICU中镇静与谵妄如何关联;2)谵妄与PTSD、焦虑和抑郁相关的后果;3)谵妄对患者ICU记忆以及出院后健康相关生活质量的影响。在一项前瞻性观察研究中,纳入了在奥胡斯或希勒勒德的ICU住院至少48小时的患者,所有年龄大于17岁。排除不讲丹麦语的患者、从其他ICU转来的患者以及因脑损伤无法进行谵妄评估的患者。患者在1周后、2个月和6个月通过电话使用六种不同问卷进行面对面访谈。在3066名入住ICU的患者中,942名符合纳入标准。主要由于无法检测谵妄,302名患者后来被排除。在其余640名患者中,65%在1天或更多天出现谵妄。无论是否对年龄、性别、疾病严重程度、手术/内科患者或ICU地点进行调整,镇静水平的波动均显著增加谵妄风险。2个月后与6个月后,分别有297名和248名患者接受访谈。两次访谈中,PTSD的发生率分别为7%和5%,焦虑为6%和4%,抑郁为10%。谵妄与任何心理测量结果均无关联。妄想记忆和情感记忆与谵妄及心理测量结果在统计学上显著相关,而事实记忆与心理测量结果无关联。如果患者患有PTSD、焦虑或抑郁,健康相关生活质量(SF - 36)在大多数领域在统计学上显著下降,但与谵妄或记忆类型无关。 结论:ICU患者镇静水平的波动增加了谵妄的发生率,但谵妄并不影响PTSD、焦虑或抑郁的风险。然而,这些受患者所拥有的记忆类型影响。如果患者患有PTSD、焦虑或抑郁,健康相关生活质量(SF - 36)会下降,但不受ICU记忆和ICU期间谵妄存在的影响。

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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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