成人重症监护幸存者创伤后应激障碍症状的患病率：系统评价和荟萃分析。
Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis.
机构信息
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
Instituto Estadual do Cérebro Paulo Niemeyer, Rua do Rezende, 156, Centro, Rio de Janeiro, RJ, 20230-026, Brazil.
出版信息
Crit Care. 2019 Jun 11;23(1):213. doi: 10.1186/s13054-019-2489-3.
BACKGROUND
As more patients are surviving intensive care, mental health concerns in survivors have become a research priority. Among these, post-traumatic stress disorder (PTSD) can have an important impact on the quality of life of critical care survivors. However, data on its burden are conflicting. Therefore, this systematic review and meta-analysis aimed to evaluate the prevalence of PTSD symptoms in adult critical care patients after intensive care unit (ICU) discharge.
METHODS
We searched MEDLINE, EMBASE, LILACS, Web of Science, PsycNET, and Scopus databases from inception to September 2018. We included observational studies assessing the prevalence of PTSD symptoms in adult critical care survivors. Two reviewers independently screened studies and extracted data. Studies were meta-analyzed using a random-effects model to estimate PTSD symptom prevalence at different time points, also estimating confidence and prediction intervals. Subgroup and meta-regression analyses were performed to explore heterogeneity. Risk of bias was assessed using the Joanna Briggs Institute tool and the GRADE approach.
RESULTS
Of 13,267 studies retrieved, 48 were included in this review. Overall prevalence of PTSD symptoms was 19.83% (95% confidence interval [CI], 16.72-23.13; I = 90%, low quality of evidence). Prevalence varied widely across studies, with a wide range of expected prevalence (from 3.70 to 43.73% in 95% of settings). Point prevalence estimates were 15.93% (95% CI, 11.15-21.35; I = 90%; 17 studies), 16.80% (95% CI, 13.74-20.09; I = 66%; 13 studies), 18.96% (95% CI, 14.28-24.12; I = 92%; 13 studies), and 20.21% (95% CI, 13.79-27.44; I = 58%; 7 studies) at 3, 6, 12, and > 12 months after discharge, respectively.
CONCLUSION
PTSD symptoms may affect 1 in every 5 adult critical care survivors, with a high expected prevalence 12 months after discharge. ICU survivors should be screened for PTSD symptoms and cared for accordingly, given the potential negative impact of PTSD on quality of life. In addition, action should be taken to further explore the causal relationship between ICU stay and PTSD, as well as to propose early measures to prevent PTSD in this population.
TRIAL REGISTRATION
PROSPERO, CRD42017075124 , Registered 6 December 2017.
背景
随着越来越多的重症患者存活下来，幸存者的心理健康问题已成为研究重点。在这些问题中，创伤后应激障碍（PTSD）可能会对重症监护幸存者的生活质量产生重要影响。然而，关于其负担的数据存在矛盾。因此，本系统评价和荟萃分析旨在评估重症监护病房（ICU）出院后成年重症监护患者 PTSD 症状的患病率。
方法
我们检索了 MEDLINE、EMBASE、LILACS、Web of Science、PsycNET 和 Scopus 数据库，检索时间从建库至 2018 年 9 月。我们纳入了评估成年重症监护幸存者 PTSD 症状患病率的观察性研究。两名审查员独立筛选研究并提取数据。使用随机效应模型对不同时间点的 PTSD 症状患病率进行荟萃分析，同时估计置信区间和预测区间。进行亚组和荟萃回归分析以探索异质性。使用 Joanna Briggs 研究所工具和 GRADE 方法评估偏倚风险。
结果
在检索到的 13267 项研究中，有 48 项研究纳入了本综述。PTSD 症状的总体患病率为 19.83%（95%置信区间，16.72-23.13；I=90%，低质量证据）。研究之间的患病率差异很大，预期患病率范围很广（95%置信区间为 3.70%-43.73%）。时点患病率估计值分别为 3 个月时为 15.93%（95%置信区间，11.15-21.35；I=90%；17 项研究）、6 个月时为 16.80%（95%置信区间，13.74-20.09；I=66%；13 项研究）、12 个月时为 18.96%（95%置信区间，14.28-24.12；I=92%；13 项研究）和>12 个月时为 20.21%（95%置信区间，13.79-27.44；I=58%；7 项研究）。
结论
大约每 5 名成年重症监护幸存者中就有 1 名可能患有 PTSD 症状，出院后 12 个月时的预期患病率较高。鉴于 PTSD 对生活质量的潜在负面影响，重症监护幸存者应接受 PTSD 症状筛查并给予相应的护理。此外，应采取行动进一步探讨 ICU 入住与 PTSD 之间的因果关系，并提出针对该人群预防 PTSD 的早期措施。
试验注册
PROSPERO，CRD42017075124，注册于 2017 年 12 月 6 日。
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