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[危重症患者的焦虑、抑郁和创伤后应激障碍]

[Anxiety, Depression, and Posttraumatic Stress Disorders in Critically Ill Patients].

作者信息

Li Chia-Chun, Feng Tsui-Hsia

机构信息

PhD, RN, Assistant Professor, School of Nursing, College of Medicine, Chang Gung University, and Assistant Research Fellow, Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Taiwan, ROC.

MSN, RN, Instructor, School of Nursing, College of Medicine, Chang Gung University, Taiwan, ROC.

出版信息

Hu Li Za Zhi. 2020 Jun;67(3):23-29. doi: 10.6224/JN.202006_67(3).04.

Abstract

The stresses that often occur in the intensive care units (ICUs) affect critically ill patients physically and psychologically. The common psychological disorders associated with these stresses are anxiety, depression, and post-traumatic stress disorders (PTSDs), which may last for several weeks, months, or even years. The anxiety levels of critically ill patients have been found to be significantly related to the use of inotropes or vasopressors, while depression has been associated with gender, days of hospitalization, use of mechanical ventilation and sedation, as well as preexisting depression. The evidence also proved that age, gender, and severity of illness are related to the development of post-traumatic stress disorders (PTSDs). To help patients' anxiety and depression, the healthcare providers should provide a safe and comfortable environment and possess reliable professional abilities for patients. More importantly, the continuity of nursing care is related to the promotion of patients' feelings of safety and the adaptation enhancement. Encouraging the presence of significant others, increasing comfort levels, and using ICU diaries in filling memory gaps, are all proved to be beneficial for the symptom relief of patients suffering PTSD. Another issue that healthcare providers should focus on is reducing the psychological distress perceived by caregivers. Providing adequate information in satisfying caregivers' need for information, enhancing their sense of control, and helping them use active coping strategies, may alleviate caregiver-perceived stresses and burdens.

摘要

重症监护病房(ICU)中经常出现的压力会对重症患者的身心造成影响。与这些压力相关的常见心理障碍包括焦虑、抑郁和创伤后应激障碍(PTSD),这些障碍可能会持续数周、数月甚至数年。研究发现,重症患者的焦虑水平与使用血管活性药物或血管加压药显著相关,而抑郁则与性别、住院天数、使用机械通气和镇静以及既往存在的抑郁有关。证据还表明,年龄、性别和疾病严重程度与创伤后应激障碍(PTSD)的发生有关。为了帮助患者缓解焦虑和抑郁,医护人员应为患者提供安全舒适的环境,并具备可靠的专业能力。更重要的是,护理的连续性与提升患者的安全感和增强适应能力有关。鼓励重要他人陪伴、提高舒适度以及使用ICU日记来填补记忆空白,都被证明对缓解PTSD患者的症状有益。医护人员应关注的另一个问题是减轻照顾者感受到的心理困扰。提供足够的信息以满足照顾者对信息的需求、增强他们的控制感并帮助他们使用积极的应对策略,可能会减轻照顾者感受到的压力和负担。

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