School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350122, China.
Fujian Provincial Hospital, Fuzhou, China.
Crit Care. 2020 Mar 6;24(1):81. doi: 10.1186/s13054-020-2797-7.
Although studies on the effectiveness of the use of ICU diaries on psychiatric disorders and quality of life have been published, the results still seem to be controversial. The study aimed to determine the effects of using an ICU diary on psychiatric disorders, sleep quality, and quality of life (QoL) in adult ICU survivors in China.
One hundred and twenty-six patients who underwent a scheduled cardiac surgery and were expected to stay ≥ 24 h in ICU were randomized to two groups (63 in each group). The patients in the intervention group received the use of ICU diaries during the period of post-ICU follow-up, while the patients in the control group received usual care without ICU diaries. The primary outcome was significant PTSD symptoms (Chinese version of Impact of Event Scale-Revised, IES-R; total score ≥ 35 was defined as significant PTSD symptoms) and its severity in patients 3 months post-ICU. The secondary outcomes included memories of the ICU at 1 month, QoL (Medical Outcomes Study 36-item Short-Form, SF-36), sleep quality (Pittsburgh Sleep Quality Index Questionnaire, PSQI), anxiety, and depression symptoms (Hospital Anxiety and Depression Scale, HADS) at 3 months.
Eighty-five and 83 patients completed the follow-up interviews at 1 month and 3 months post-ICU, respectively. Significant PTSD symptoms were reported by 6 of 41 (14.63%) in the intervention group vs 9 of 42 (21.43%) in the control group (risk difference, - 9% [95% CI, - 2% to 21%], P = 0.10). There was no significant differences between groups in IES-R score, symptoms of intrusion, symptoms of avoidance, numbers of memories of feeling and delusional memories, SF-36 score and anxiety score (P > 0.05), while significant differences were found in symptom of hyperarousal score, numbers of factual memories and PSQI score (P < 0.05). No adverse effect was reported.
Using an ICU diary is not useful for preventing PTSD symptoms and anxiety symptoms and preserving the quality of life of the patients at 3 months post-ICU, while it significantly improves the survivor's factual memory of ICU and sleep quality, and prevents the hyperarousal symptom.
Chinese Clinical Trial Registry, ChiCTR-IOR-16009109, registered on 28 August 2016.
虽然已经发表了关于 ICU 日记对精神障碍和生活质量影响的研究，但结果似乎仍存在争议。本研究旨在确定在中国 ICU 幸存者中使用 ICU 日记对精神障碍、睡眠质量和生活质量（QoL）的影响。
126 名接受择期心脏手术并预计在 ICU 中停留≥24 小时的患者被随机分为两组（每组 63 名）。干预组患者在 ICU 随访期间使用 ICU 日记，而对照组患者则接受常规护理，不使用 ICU 日记。主要结局为 ICU 后 3 个月时患者出现明显 PTSD 症状（修订后的事件影响量表中文版，IES-R；总分≥35 定义为明显 PTSD 症状）及其严重程度。次要结局包括 ICU 记忆 1 个月时、QoL（医疗结局研究 36 项简短量表，SF-36）、睡眠质量（匹兹堡睡眠质量指数问卷，PSQI）、焦虑和抑郁症状（医院焦虑和抑郁量表，HADS）3 个月时。
85 名和 83 名患者分别在 ICU 后 1 个月和 3 个月完成了随访访谈。干预组有 6 名（14.63%）患者出现明显 PTSD 症状，对照组有 9 名（21.43%）患者出现明显 PTSD 症状（风险差异，-9%[95%CI，-2%至 21%]，P=0.10）。两组之间 IES-R 评分、侵入症状、回避症状、感觉和妄想记忆数量、SF-36 评分和焦虑评分均无显著差异（P>0.05），而警觉症状评分、事实记忆数量和 PSQI 评分有显著差异（P<0.05）。未报告不良事件。
使用 ICU 日记不能预防 ICU 后 3 个月时 PTSD 症状和焦虑症状的发生，也不能维持患者的生活质量，但可显著改善患者对 ICU 的真实记忆和睡眠质量，预防警觉症状。
中国临床试验注册中心，ChiCTR-IOR-16009109，于 2016 年 8 月 28 日注册。
