Baumbach Philipp, Götz Theresa, Günther Albrecht, Weiss Thomas, Meissner Winfried
1Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany. 2Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany. 3Biomagnetic Center, Hans-Berger-Klinik for Neurology, Jena University Hospital, Jena, Germany. 4Department of Biological and Clinical Psychology, Friedrich Schiller University of Jena, Jena, Germany.
Crit Care Med. 2016 Jun;44(6):1129-37. doi: 10.1097/CCM.0000000000001635.
There is only limited knowledge about chronic pain conditions resulting from critical care. Experimental and clinical data suggest a close relationship between inflammation and pain perception. Since sepsis is the most severe form of systemic inflammation, the primary objective was to evaluate chronic pain states and functional impairment of septic and nonseptic patients 6 months after discharge from ICU. Second, we aimed to obtain the total prevalence and characteristics of chronic ICU-related pain.
Case-control study.
Observational study in long-term survivors of mixed surgical and medical ICUs.
Septic and nonseptic survivors of critical care (n = 207) and healthy controls (n = 46).
None.
We collected comprehensive information on patients' past and present pain 6 months after ICU discharge by means of the German pain questionnaire. Pain intensity levels and pain interference ratings were compared between septic and nonseptic patients and healthy controls. We found no differences in prevalence, severity, and interference of pain between septic and nonseptic patients. However, both patient groups differed significantly from controls. In secondary analysis, a third of all patients reported chronic clinically relevant pain associated with the ICU stay 6 months after ICU discharge. Half of these patients experienced chronic pain conditions before ICU admission and reported additional sources of pain. Most important, 16% of all patients had no preexisting pain condition and now experience chronic ICU-related pain. The majority of patients with chronic ICU-related pain reported a high degree of disabling pain, limiting daily activities.
A high percentage of former ICU patients develop chronic pain conditions associated with critical care. These patients differ significantly from control data in terms of pain intensity and show high levels of interference with pain. The presence of sepsis per se seems to play a marginal role for the development of chronic ICU-related pain.
关于重症监护导致的慢性疼痛状况，目前了解有限。实验和临床数据表明炎症与疼痛感知之间存在密切关系。由于脓毒症是全身性炎症的最严重形式，主要目的是评估脓毒症患者和非脓毒症患者在从重症监护病房（ICU）出院6个月后的慢性疼痛状态和功能损害。其次，我们旨在获取慢性ICU相关疼痛的总体患病率及特征。
病例对照研究。
对外科和内科混合ICU的长期幸存者进行观察性研究。
重症监护的脓毒症和非脓毒症幸存者（n = 207）以及健康对照者（n = 46）。
无。
我们通过德国疼痛问卷收集了患者在ICU出院6个月后过去和当前疼痛的全面信息。比较了脓毒症患者、非脓毒症患者和健康对照者之间的疼痛强度水平和疼痛干扰评分。我们发现脓毒症患者和非脓毒症患者在疼痛的患病率、严重程度和干扰方面没有差异。然而，这两组患者与对照组相比均有显著差异。在二次分析中，三分之一的患者报告在ICU出院6个月后存在与ICU住院相关的慢性临床相关疼痛。这些患者中有一半在ICU入院前就有慢性疼痛状况，并报告了其他疼痛来源。最重要的是，16%的患者既往无疼痛状况，现在出现了慢性ICU相关疼痛。大多数患有慢性ICU相关疼痛的患者报告疼痛严重致残，限制了日常活动。
很大比例的 former ICU患者出现与重症监护相关的慢性疼痛状况。这些患者在疼痛强度方面与对照数据有显著差异，且疼痛干扰程度较高。脓毒症本身的存在似乎在慢性ICU相关疼痛的发生中起次要作用。
