University of Tampere, School of Health Sciences, Finland.
Centre for Research Methods, Department of Social Research, University of Helsinki, Helsinki, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Aust Crit Care. 2019 Mar;32(2):116-121. doi: 10.1016/j.aucc.2018.02.009. Epub 2018 Mar 23.
Intensive care admissions during pregnancy, childbirth, and postpartum period are relatively well investigated. However, very little is known about these obstetric patients' health-related quality of life (HRQoL) before and after critical care.
The objective of this study was to assess obstetric patients' HRQoL before intensive care admission (baseline) and at 6 months after discharge (follow-up) DESIGN: This was a retrospective database study. In a 5-year period, the data of all women admitted to the intensive care unit (ICU) during pregnancy, delivery, or up to 42 days postpartum were analysed.
Four multidisciplinary ICUs of Finnish University hospitals participated. The HRQoL was assessed using the EuroQol-5D (EQ-5D) instrument with utility score (EQsum) and visual analogue scale (EQ-VAS).
A total of 283 obstetric patients were identified from the clinical information system. Of these, 99 (35%) completed the EQ-5D questionnaires both at baseline and follow-up, and 65 of them (23%) completed EQ-VAS. The comparison of patients' EQsum scores before intensive care admission and after discharge showed that patients' HRQoL remained good (0.970 vs 0.972) (max 1.0) or increased (0.788 vs 0.982) in 80.8% of the patients. Patients reported improved overall health on the EQ-VAS at 6 months follow-up (EQ-VAS mean, 71.86 vs 88.20; p ≤ 0.001) (max 100). However, 19.2% of the patients had lower HRQoL (EQsum mean 0.987 vs 0.798) at follow-up. Following intensive care, 15% of the patients had more pain/discomfort, and 11% expressed more depression/anxiety. Multiparous patients were more likely to suffer from worsened depression/anxiety (p = 0.024).
In the majority of the obstetric patients, HRQoL at 6 months follow-up remained good or had increased from baseline. However, nearly one-fifth of the patients had impaired HRQoL after discharge. Thus, intensive care management should take in to consideration follow-up program after intensive care of ICU-admitted obstetric patients.
重症监护病房中孕妇、分娩和产后期间的收治情况已得到充分研究。然而，关于这些产科患者在重症监护之前和之后的健康相关生活质量（HRQoL）知之甚少。
本研究旨在评估接受重症监护前（基线）和出院后 6 个月（随访）产科患者的 HRQoL。
这是一项回顾性数据库研究。在 5 年期间，分析了所有在妊娠、分娩期间或产后 42 天内入住重症监护病房（ICU）的女性患者的数据。
芬兰大学医院的 4 个多学科 ICU 参与了本研究。使用 EuroQol-5D（EQ-5D）工具评估 HRQoL，采用效用评分（EQsum）和视觉模拟量表（EQ-VAS）。
从临床信息系统中确定了 283 名产科患者。其中，99 名（35%）患者在基线和随访时完成了 EQ-5D 问卷，65 名（23%）患者完成了 EQ-VAS。比较患者重症监护前和出院后的 EQsum 评分，发现 80.8%的患者 HRQoL 保持良好（0.970 与 0.972）（最大值 1.0）或改善（0.788 与 0.982）。在 6 个月的随访中，患者报告整体健康状况在 EQ-VAS 上有所改善（EQ-VAS 平均值，71.86 与 88.20；p≤0.001）（最大值 100）。然而，19.2%的患者在随访时 HRQoL 较低（EQsum 平均值 0.987 与 0.798）。接受重症监护后，15%的患者疼痛/不适增加，11%患者表示抑郁/焦虑增加。多产妇更有可能出现恶化的抑郁/焦虑（p=0.024）。
在大多数产科患者中，6 个月随访时的 HRQoL 保持良好或较基线时有所改善。然而，近五分之一的患者出院后 HRQoL 受损。因此，重症监护病房管理应考虑为 ICU 收治的产科患者制定重症监护后的随访方案。
