Castillo Maria I, Cooke Marie L, Macfarlane Bonnie, Aitken Leanne M
School of Nursing and Midwifery, Griffith University, Australia; NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Menzies Health Institute Queensland, Australia; Princess Alexandra Hospital, Australia.
NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation, Menzies Health Institute Queensland, Australia; School of Nursing and Midwifery, Griffith University, Australia.
Aust Crit Care. 2016 Aug;29(3):158-64. doi: 10.1016/j.aucc.2015.09.003. Epub 2015 Nov 6.
Posttraumatic stress symptoms are common after intensive care treatment. The influence of anxiety during critical illness on the development of posttraumatic stress symptoms needs to be investigated.
To determine the association between anxiety during critical illness (state and trait components) and posttraumatic stress symptoms over six months after ICU discharge.
Prospective study including 141 patients admitted ≥24h to a closed mixed adult ICU in a tertiary hospital. State anxiety was assessed with the Faces Anxiety Scale during ICU stay. Trait anxiety was measured with the State-Trait Anxiety Inventory Form Y-2. Posttraumatic stress symptoms were measured at three and six months after ICU discharge using the Post-Traumatic Stress Symptoms 10-Question Inventory. Clinical and demographical data were also collected. Mixed effect regression models were used to determine if state and trait anxiety were factors significantly associated with posttraumatic stress symptoms over time.
Moderate to severe levels of state anxiety in ICU were reported by 81 (57%) participants. Levels of trait anxiety (median 36 IQR: 29-47) were similar to the Australian population. High levels of posttraumatic stress symptoms occurred at three (n=19, 19%) and six months (n=15, 17%). Factors independently associated with posttraumatic stress symptoms were trait anxiety (2.2; 95% CI, 0.3-4.1; p=0.02), symptoms of anxiety after ICU discharge (0.6; 95% CI, 0.2-1.1; p=0.005), younger age (-1.4; 95% CI, -2.6 to -0.2; p=0.02) and evidence of mental health treatment prior to the ICU admission (5.2; 95% CI, 1.5-8.9; p=0.006).
Posttraumatic stress symptoms occurred in a significant proportion of ICU survivors and were significantly associated with higher levels of trait anxiety, younger age, mental health treatment prior to the ICU admission and more symptoms of anxiety after ICU discharge. Early assessment and interventions directed to reduce state and trait anxiety in ICU survivors may be of benefit.
重症监护治疗后创伤后应激症状很常见。危重病期间焦虑对创伤后应激症状发展的影响需要进行研究。
确定危重病期间（状态和特质成分）的焦虑与重症监护病房（ICU）出院后六个月内创伤后应激症状之间的关联。
前瞻性研究，纳入141例在三级医院成人综合性封闭ICU住院≥24小时的患者。在ICU住院期间用面部焦虑量表评估状态焦虑。用状态-特质焦虑量表Y-2型测量特质焦虑。在ICU出院后3个月和6个月时，使用创伤后应激症状10项问卷测量创伤后应激症状。还收集了临床和人口统计学数据。使用混合效应回归模型确定状态和特质焦虑是否是随时间与创伤后应激症状显著相关的因素。
81名（57%）参与者报告在ICU时有中度至重度状态焦虑。特质焦虑水平（中位数36，四分位间距：29-47）与澳大利亚人群相似。在3个月时（n = 19，19%）和6个月时（n = 15，17%）出现高水平的创伤后应激症状。与创伤后应激症状独立相关的因素有特质焦虑（2.2；95%置信区间，0.3-4.1；p = 0.02）、ICU出院后的焦虑症状（0.6；95%置信区间，0.2-1.1；p = 0.005）、较年轻的年龄（-1.4；95%置信区间，-2.6至-0.2；p = 0.02）以及ICU入院前有心理健康治疗史（5.2；95%置信区间，1.5-8.9；p = 0.006）。
相当比例的ICU幸存者出现创伤后应激症状，且与较高水平的特质焦虑、较年轻的年龄、ICU入院前的心理健康治疗以及ICU出院后更多的焦虑症状显著相关。对ICU幸存者进行早期评估并采取干预措施以降低状态和特质焦虑可能有益。
