National Medical University named after O.O.Bogomolets, Taras Shevchenko Boulevard, 13, Kyiv, 01601, Ukraine.
BMC Anesthesiol. 2021 Oct 30;21(1):263. doi: 10.1186/s12871-021-01482-8.
The 82.1% treatment failure of post-traumatic stress disorder (PTSD), associated with gunshot wounds, is related to high incidence of chronic pain syndrome as well as resistance to the PTSD treatment. Defining treatment failure predictors among the PTSD patients with gunshot extremity wounds and the following therapy would improve treatment outcomes.
A total of 218 patients completed the study. The Mississippi Scale for Combat-Related PTSD (M-PTSD) was used for assessment of the treatment outcome rate. The risk relation between treatment failure and factors was assessed by a univariate or multivariate logistic regression method, with the model accuracy measured by the AUC - Area under the ROC curve. The odds ratio (OR) was considered for the qualitative factor assessment.
The predictors of the PTSD treatment failure among the patients with gunshot wounds to the extremities are: 1) anesthesia type: the risk of failure is higher with the general anesthesia compared to the regional (p = 0.002), OR = 0.30 (95% CI 0.13-0.69) and the regional one with sedation (p = 0.004), OR = 0.30 (95% CI 0,14-0.65); 2) severe postoperative pain: the risk of treatment failure rises with increased pain intensity assessed by the visual analogue scale (p = 0.02), OR = 3.2 (95% CI 1.2-8.3).
The analysis showed that administration of general anesthesia compared to the regional one (regardless of the sedation) and high postoperative pain intensity are associated with higher risk of the PTSD treatment failure among patients with gunshot wounds to the extremities. The preference of regional anesthesia and postoperative pain control may potentially improve the treatment outcomes.
ClinicalTrials.gov: Retrospectively registered on December 30, 2020, NCT04689022 .
创伤后应激障碍（PTSD）的治疗失败率为 82.1%，与枪击伤有关，这与慢性疼痛综合征的高发以及对 PTSD 治疗的抵抗有关。在患有枪击伤肢体的 PTSD 患者中定义治疗失败的预测因素，并对以下治疗方法进行研究，将改善治疗效果。
共有 218 名患者完成了这项研究。采用密西西比战斗相关 PTSD 量表（M-PTSD）评估治疗结果率。通过单变量或多变量逻辑回归方法评估治疗失败与因素之间的风险关系，用 AUC-ROC 曲线下面积衡量模型准确性。定性因素评估采用比值比（OR）。
肢体枪击伤 PTSD 患者治疗失败的预测因素有：1）麻醉类型：全身麻醉的失败风险高于区域麻醉（p=0.002），OR=0.30（95%CI 0.13-0.69），区域麻醉加镇静（p=0.004），OR=0.30（95%CI 0.14-0.65）；2）严重术后疼痛：疼痛强度增加，即视觉模拟评分（p=0.02），治疗失败风险升高，OR=3.2（95%CI 1.2-8.3）。
分析表明，与区域麻醉（无论镇静与否）相比，全身麻醉以及高术后疼痛强度与肢体枪击伤 PTSD 患者治疗失败风险增加相关。区域麻醉和术后疼痛控制的偏好可能会改善治疗效果。
ClinicalTrials.gov：2020 年 12 月 30 日回顾性注册，NCT04689022。
