Jeitziner Marie-Madlen, Hamers Jan P H, Bürgin Reto, Hantikainen Virpi, Zwakhalen Sandra M G
Department of Intensive Care Medicine, University Hospital (Inselspital), Bern, Switzerland.
Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
J Clin Nurs. 2015 Sep;24(17-18):2419-28. doi: 10.1111/jocn.12801. Epub 2015 May 23.
This study investigated whether an intensive care unit (ICU) stay is associated with persistent pain, anxiety and agitation in critically ill older patients.
Patients hospitalised in the ICU are at risk for experiencing pain, anxiety and agitation, but long-term consequences for older patients have rarely been investigated.
Prospective nonrandomised longitudinal study.
Pain, anxiety and agitation, measured with a numeric rating scale (0-10), were assessed in older patients (≥65 years) hospitalised in the medical-surgical ICU of a university hospital. Agitation during the ICU was assessed with the Richmond Agitation-Sedation Scale. Data collection occurred during the ICU, one week after the stay and six and 12 months after hospital discharge. Data were collected from an age-matched community-based comparison group at recruitment and after six and 12 months. Study recruitment took place from December 2008-April 2011.
This study included 145 older patients (ICU group) and 146 comparison group participants. Pain was higher in the ICU group one week after discharge, although pain levels in general were low. Both groups reported no or low levels of pain after six and 12 months. Anxiety levels in general were low, although higher in the ICU group one week after ICU discharge. After six and 12 months, anxiety in both groups was comparable. Throughout the study, levels of agitation were similar in both groups.
Critically ill older patients did not experience increased pain, anxiety or agitation 12 months after an ICU stay.
This study positively shows that an ICU stay is not associated with persistent pain, anxiety and agitation thus providing additional information to older patients and their families when making intensive care treatment decisions. Adequate management of pain during and after an ICU stay may minimise the suffering of older patients.
本研究调查了重症监护病房（ICU）住院是否与重症老年患者的持续性疼痛、焦虑和躁动相关。
入住ICU的患者有经历疼痛、焦虑和躁动的风险，但老年患者的长期后果很少被研究。
前瞻性非随机纵向研究。
使用数字评分量表（0-10）对一所大学医院内科-外科ICU住院的老年患者（≥65岁）的疼痛、焦虑和躁动进行评估。使用里士满躁动镇静量表评估ICU期间的躁动情况。在ICU期间、住院一周后以及出院后6个月和12个月进行数据收集。在招募时以及6个月和12个月后从年龄匹配的社区对照组收集数据。研究招募于2008年12月至2011年4月进行。
本研究纳入了145名老年患者（ICU组）和146名对照组参与者。出院一周后，ICU组的疼痛程度较高，尽管总体疼痛水平较低。两组在6个月和12个月后报告的疼痛程度均为无或低水平。总体焦虑水平较低，尽管ICU组在ICU出院一周后的焦虑水平较高。6个月和12个月后，两组的焦虑水平相当。在整个研究过程中，两组的躁动水平相似。
重症老年患者在ICU住院12个月后并未出现疼痛、焦虑或躁动增加的情况。
本研究明确表明，ICU住院与持续性疼痛、焦虑和躁动无关，从而在老年患者及其家属做出重症监护治疗决策时提供了更多信息。在ICU住院期间及之后对疼痛进行充分管理可能会减轻老年患者的痛苦。
