创伤后应激症状与 ICU 出院时的综合感知

Post-traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge.

机构信息

Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.

Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.

出版信息

Nurs Crit Care. 2020 Mar;25(2):117-125. doi: 10.1111/nicc.12466. Epub 2019 Aug 16.

DOI:10.1111/nicc.12466

PMID:31418993

Abstract

BACKGROUND

Post-traumatic stress (PTS) symptoms following intensive care unit (ICU) treatment can lead to post-traumatic stress disorder and represent a severe health burden. In trauma patients, a strong sense of coherence (SOC) is associated with fewer PTS symptoms. However, this association has not been investigated in a general ICU sample.

AIMS AND OBJECTIVES

To examine the occurrence of PTS symptoms in general ICU patients early after ICU discharge and to assess possible associations between PTS symptoms and SOC, ICU memory, pain, and demographic and clinical characteristics.

DESIGN

This was a cross-sectional study.

METHODS

Adult patients aged ≥18 years admitted for ≥24 hours to five ICUs between 2014 and 2016 were recruited. PTS symptoms and SOC were measured at the ward within the first week after discharge from the ICU using the Posttraumatic Stress Scale-10 and Sense of Coherence Scale-13. Multiple linear regression analysis was used to identify associations between PTS symptoms and SOC and the selected independent variables.

RESULTS

A total of 523 patients were included (17.8% trauma patients; median age 57 years [range 18-94]; 53.3% male). The prevalence of clinically significant PTS symptoms was 32%. After adjustments for gender and age, lower SOC (P < 0.001), more ICU delusional memories (P < 0.001), greater pain interference (P < 0.001), not being a trauma patient (P = 0.02), and younger age (P = 0.03) were significantly associated with more PTS symptoms.

CONCLUSIONS

One third of patients experienced clinically relevant PTS symptoms early after discharge from the ICU. In the present study, SOC, delusional memory, pain interference, younger age, and not being a trauma patient were factors associated with more PTS symptoms.

RELEVANCE TO CLINICAL PRACTICE

Early individual follow up after ICU discharge focusing on pain relief and delusional memory may reduce PTS symptoms, with a potential of improving rehabilitation.

摘要

背景

重症监护病房（ICU）治疗后出现创伤后应激（PTS）症状可导致创伤后应激障碍，并代表严重的健康负担。在创伤患者中，较强的领悟社会支持能力（SOC）与较少的 PTS 症状相关。然而，这一关联尚未在一般 ICU 样本中进行研究。

目的

在 ICU 出院后早期检查一般 ICU 患者 PTS 症状的发生情况，并评估 PTS 症状与 SOC、ICU 记忆、疼痛以及人口统计学和临床特征之间的可能关联。

设计

这是一项横断面研究。

方法

2014 年至 2016 年间，招募了 5 个 ICU 中入住时间≥24 小时的年龄≥18 岁的成年患者。使用创伤后应激量表-10 和领悟社会支持量表-13，在 ICU 出院后第一周内在病房内测量 PTS 症状和 SOC。使用多元线性回归分析来确定 PTS 症状与 SOC 与所选自变量之间的关联。

结果

共纳入 523 名患者（17.8%为创伤患者；中位年龄 57 岁[范围 18-94]；53.3%为男性）。临床上显著 PTS 症状的患病率为 32%。在调整性别和年龄后，较低的 SOC（P<0.001）、更多的 ICU 妄想记忆（P<0.001）、更大的疼痛干扰（P<0.001）、非创伤患者（P=0.02）和更年轻的年龄（P=0.03）与更多 PTS 症状显著相关。