Division of Emergencies and Critical Care, Department of Postoperative and Intensive Care, Oslo University Hospital, Oslo, Norway.
Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway.
Crit Care Med. 2020 Dec;48(12):e1218-e1225. doi: 10.1097/CCM.0000000000004628.
To investigate the effect of nurse-led consultations on reducing post-traumatic stress symptoms and increasing sense of coherence in discharged ICU patients with clinically relevant post-traumatic stress symptoms and to identify variables associated with symptoms 12 months later.
A pragmatic nonblinded randomized controlled trial.
Five surgical and medical ICUs at Oslo University Hospital.
Adult patients treated in the ICU greater than or equal to 24 hours were screened with Post-Traumatic Stress Scale 10 intensive part B after ICU discharge. Those scoring greater than or equal to 25 were included in the study.
Patients randomized to intervention group were offered three nurse-led consultations within 2 months, and patients in the control group received standard care.
Sense of Coherence Scale 13 and Post-Traumatic Stress Scale 10 intensive part B were completed after inclusion, and reevaluated after 3, 6, and 12 months. Linear mixed model for repeated measures and linear regression analyses were performed. Among 523 screened patients, 111 and 113 were randomized to intervention group and control group, respectively. Mean Post-Traumatic Stress Scale 10 intensive part B score was 37 (±10) before randomization. No differences in post-traumatic stress symptoms or sense of coherence were found between intervention group versus control group, with a mean Post-Traumatic Stress Scale 10 intensive part B score 39 (95% CI, 37-41) versus 37 (95% CI, 35-39), 32 (95% CI, 28-35) versus 32 (95% CI, 29-35), 31 (95% CI, 28-34) versus 30 (95% CI, 27-33), and 31 (95% CI, 28-34) versus 29 (95% CI, 26-33) at baseline, 3, 6, and 12 months, respectively. There was a significantly reduced Post-Traumatic Stress Scale 10 intensive part B score for both groups during the year (p = 0.001). Low sense of coherence, pain, and previous psychiatric problems were associated with increased level of post-traumatic stress symptoms at 12 months.
Nurse-led consultations did not reveal any significant effect on post-traumatic stress symptoms or sense of coherence after ICU discharge in patients with clinically relevant symptoms.
探讨护士主导的咨询对减少创伤后应激症状和增加具有临床相关创伤后应激症状的 ICU 出院患者的整体感的影响，并确定与 12 个月后症状相关的变量。
一项实用的非盲随机对照试验。
奥斯陆大学医院的 5 个外科和内科 ICU。
入住 ICU 超过 24 小时的成年患者在 ICU 出院后用创伤后应激量表 10 密集部分 B 进行筛查。得分大于等于 25 分的患者被纳入研究。
随机分配到干预组的患者在 2 个月内接受 3 次护士主导的咨询，而对照组的患者接受标准护理。
在纳入后完成整体感量表 13 和创伤后应激量表 10 密集部分 B，并在 3、6 和 12 个月后重新评估。采用重复测量线性混合模型和线性回归分析。在筛选出的 523 名患者中，111 名和 113 名患者分别随机分配到干预组和对照组。随机分组前创伤后应激量表 10 密集部分 B 的平均得分为 37（±10）。干预组与对照组之间的创伤后应激症状或整体感无差异，创伤后应激量表 10 密集部分 B 的平均得分为 39（95%CI，37-41）与 37（95%CI，35-39），32（95%CI，28-35）与 32（95%CI，29-35），31（95%CI，28-34）与 30（95%CI，27-33），以及 31（95%CI，28-34）与 29（95%CI，26-33）在基线、3、6 和 12 个月时分别为 31（95%CI，28-34）。两组在这一年中创伤后应激量表 10 密集部分 B 的评分均显著降低（p=0.001）。整体感低、疼痛和以前的精神问题与 12 个月时的创伤后应激症状水平升高相关。
在具有临床相关症状的 ICU 出院患者中，护士主导的咨询并未显示对创伤后应激症状或整体感有任何显著影响。
