Boersma-van Dam Elise, Engelhard Iris M, van de Schoot Rens, Van Loey Nancy E E
Association of Dutch Burn Centres, Beverwijk, Netherlands.
Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, Netherlands.
Front Psychol. 2022 Jan 24;12:794364. doi: 10.3389/fpsyg.2021.794364. eCollection 2021.
Fatigue after burns is often attributed to the hyperinflammatory and hypermetabolic response, while it may be best understood from a bio-psychological perspective, also involving the neuro-endocrine system. This longitudinal multi-center study examined the course of fatigue up to 18 months postburn. The contribution of bio-psychological factors, including burn severity, pain, and acute PTSD symptoms, to the course and persistence of fatigue was studied in a multifactorial model.
Participants were 247 adult burn survivors. Fatigue symptoms were assessed with the Multidimensional Fatigue Inventory during the acute phase and subsequently at 3, 6, 12, and 18 months postburn, and were compared to population norms. Age, gender, burn severity, acute PTSD symptoms and pain were assessed as potential predictors of fatigue over time in a latent growth model.
At 18 months postburn, 46% of the burn survivors reported fatigue, including 18% with severe fatigue. In the acute phase, higher levels of fatigue were related to multiple surgeries, presence of pain, and higher levels of acute PTSD symptoms. Fatigue gradually decreased over time with minor individual differences in rate of decrease. At 18 months, pain and acute PTSD symptoms remained significant predictors of fatigue levels.
Protracted fatigue after burns was found in almost one out of five burn survivors and was associated with both pain and acute PTSD symptoms. Early detection of PTSD symptoms and early psychological interventions aimed at reducing PTSD symptoms and pain may be warranted to reduce later fatigue symptoms.
烧伤后的疲劳通常归因于炎症反应过度和代谢亢进，但从生物心理学角度可能能更好地理解，这还涉及神经内分泌系统。这项纵向多中心研究考察了烧伤后长达18个月的疲劳病程。在多因素模型中研究了生物心理因素，包括烧伤严重程度、疼痛和急性创伤后应激障碍（PTSD）症状，对疲劳病程和持续性的影响。
参与者为247名成年烧伤幸存者。在急性期以及随后烧伤后3个月、6个月、12个月和18个月，使用多维疲劳量表评估疲劳症状，并与总体标准进行比较。在潜在增长模型中，将年龄、性别、烧伤严重程度、急性PTSD症状和疼痛评估为随时间变化的疲劳潜在预测因素。
烧伤后18个月，46%的烧伤幸存者报告有疲劳，其中18%为严重疲劳。在急性期，较高水平的疲劳与多次手术、疼痛的存在以及较高水平的急性PTSD症状有关。随着时间推移，疲劳逐渐减轻，减轻速度存在微小个体差异。在18个月时，疼痛和急性PTSD症状仍然是疲劳水平的显著预测因素。
几乎五分之一的烧伤幸存者存在烧伤后持续性疲劳，且与疼痛和急性PTSD症状均有关。可能有必要早期发现PTSD症状并进行旨在减轻PTSD症状和疼痛的早期心理干预，以减少后期的疲劳症状。
