地塞米松对心脏手术后及重症监护入院后创伤后应激障碍和抑郁症状的影响：一项随机对照试验的纵向随访

The Effect of Dexamethasone on Symptoms of Posttraumatic Stress Disorder and Depression After Cardiac Surgery and Intensive Care Admission: Longitudinal Follow-Up of a Randomized Controlled Trial.

作者信息

Kok Lotte, Hillegers Manon H, Veldhuijzen Dieuwke S, Cornelisse Sandra, Nierich Arno P, van der Maaten Joost M, Rosseel Peter M, Hofland Jan, Sep Milou S, Dieleman Jan M, Vinkers Christiaan H, Peelen Linda M, Joëls Marian, van Dijk Diederik

机构信息

1Department of Anesthesiology and Intensive Care, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.2Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.3Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands.4Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.5Department of Anesthesiology, Isala Clinics, Zwolle, The Netherlands.6Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands.7Department of Anesthesiology, Amphia Hospital, Breda, The Netherlands.8Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.9Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

出版信息

Crit Care Med. 2016 Mar;44(3):512-20. doi: 10.1097/CCM.0000000000001419.

DOI:10.1097/CCM.0000000000001419

PMID:26540396

Abstract

OBJECTIVE

Cardiac surgery and postoperative admission to the ICU may lead to posttraumatic stress disorder and depression. Perioperatively administered corticosteroids potentially alter the risk of development of these psychiatric conditions, by affecting the hypothalamic-pituitary-adrenal axis. However, findings of previous studies are inconsistent. We aimed to assess the effect of a single dose of dexamethasone compared with placebo on symptoms of posttraumatic stress disorder and depression and health-related quality of life after cardiac surgery and ICU admission.

DESIGN

Follow-up study of a randomized clinical trial.

SETTING

Five Dutch heart centers.

PATIENTS

Cardiac surgery patients (n = 1,244) who participated in the Dexamethasone for Cardiac Surgery trial.

INTERVENTIONS

A single intraoperative IV dose of dexamethasone or placebo was administered in a randomized, double-blind way.

MEASUREMENTS AND MAIN RESULTS

Symptoms of posttraumatic stress disorder, depression, and health-related quality of life were assessed with validated questionnaires 1.5 years after randomization. Data were available for 1,125 patients (90.4%); of which 561 patients received dexamethasone and 564 patients received placebo. Overall, the prevalence of psychopathology was not influenced by dexamethasone. Posttraumatic stress disorder and depression were present in, respectively, 52 patients (9.3%) and 69 patients (12.3%) who received dexamethasone and in 66 patients (11.7%) and 78 patients (13.8%) who received placebo (posttraumatic stress disorder: odds ratio, 0.82; 95% CI, 0.55-1.20; p = 0.30; depression: odds ratio, 0.92; 95% CI, 0.64-1.31; p = 0.63). Subgroup analysis revealed a lower prevalence of posttraumatic stress disorder (odds ratio, 0.23; 95% CI, 0.07-0.72; p < 0.01) and depression (odds ratio, 0.29; 95% CI, 0.11-0.77; p < 0.01) in female patients after dexamethasone administration. Health-related quality of life did not differ between groups and was not associated with psychopathology.

CONCLUSIONS

Overall, our findings suggest that exogenous administration of the glucocorticoid receptor agonist dexamethasone-compared with placebo-during cardiac surgery does not positively or negatively affect the prevalence of posttraumatic stress disorder and depression. However, in female patients, beneficial effects on the occurrence of posttraumatic stress disorder and depression may be present.

摘要

目的

心脏手术及术后入住重症监护病房（ICU）可能导致创伤后应激障碍和抑郁症。围手术期使用皮质类固醇可能通过影响下丘脑 - 垂体 - 肾上腺轴来改变这些精神疾病的发生风险。然而，先前研究的结果并不一致。我们旨在评估与安慰剂相比，单剂量地塞米松对心脏手术及入住ICU后创伤后应激障碍和抑郁症症状以及健康相关生活质量的影响。

设计

一项随机临床试验的随访研究。

地点

五个荷兰心脏中心。

患者

参与心脏手术用地塞米松试验的心脏手术患者（n = 1244）。

干预措施

术中随机、双盲静脉注射单剂量地塞米松或安慰剂。

测量指标及主要结果

随机分组1.5年后，使用经过验证的问卷评估创伤后应激障碍、抑郁症症状以及健康相关生活质量。1125例患者（90.4%）有可用数据；其中561例患者接受地塞米松治疗，564例患者接受安慰剂治疗。总体而言，精神病理学的患病率不受地塞米松影响。接受地塞米松治疗的患者中，分别有52例（9.3%）患创伤后应激障碍和69例（12.3%）患抑郁症；接受安慰剂治疗的患者中，分别有66例（11.7%）患创伤后应激障碍和78例（13.8%）患抑郁症（创伤后应激障碍：比值比，0.82；95%可信区间，0.5～1.20；p = 0.30；抑郁症：比值比，0.92；95%可信区间，0.64～1.31；p = 0.63）。亚组分析显示，地塞米松给药后女性患者创伤后应激障碍（比值比，0.23；95%可信区间，0.07～0.72；p < 0.01）和抑郁症（比值比，0.29；95%可信区间，0.11～0.77；p < 0.01）的患病率较低。两组间健康相关生活质量无差异，且与精神病理学无关。