分析性镇静与 ARDS 幸存者精神症状和健康相关生活质量的关系：DACAPO 研究的事后分析。
Association of analgosedation with psychiatric symptoms and health-related quality of life in ARDS survivors: Post hoc analyses of the DACAPO study.
机构信息
Department of Anaesthesiology, University Medical Centre Regensburg, Regensburg, Germany.
Centre of Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany.
出版信息
PLoS One. 2022 Oct 21;17(10):e0275743. doi: 10.1371/journal.pone.0275743. eCollection 2022.
BACKGROUND
The acute respiratory distress syndrome (ARDS) is a life-threatening condition with the risk of developing hypoxia and thus requires for invasive mechanical ventilation a long-term analgosedation. Yet, prolonged analgosedation may be a reason for declining health-related quality of life (HRQoL) and the development of psychiatric disorders.
METHODS
We used data from the prospective observational nation‑wide ARDS study across Germany (DACAPO) to investigate the influence of sedation and analgesia on HRQoL and the risk of psychiatric symptoms in ARDS survivors 3, 6 and 12 months after their discharge from the intensive care unit (ICU). HRQoL was measured with the Physical and Mental Component Scale of the Short‑Form 12 Questionnaire (PCS‑12, MCS‑12). The prevalence of psychiatric symptoms (depression and post‑traumatic stress disorder [PTSD]) was assessed using the Patient Health Questionnaire‑9 and the Post‑Traumatic Stress Syndrome‑14. The associations of analgosedation with HRQoL and psychiatric symptoms were investigated by means of multivariable linear regression models.
RESULTS
The data of 134 ARDS survivors (median age [IQR]: 55 [44-64], 67% men) did not show any significant association between analgosedation and physical or mental HRQoL up to 1 year after ICU discharge. Multivariable linear regression analysis (B [95%‑CI]) yielded a significant association between symptoms of psychiatric disorders and increased cumulative doses of ketamine up to 6 months after ICU discharge (after 3 months: depression: 0.15 [0.05, 0.25]; after 6 months: depression: 0.13 [0.03, 0.24] and PTSD: 0.42 [0.04, 0.80)]).
CONCLUSIONS
Up to 1 year after ICU discharge, analgosedation did not influence HRQoL of ARDS survivors. Prolonged administration of ketamine during ICU treatment, however, was positively associated with the risk of psychiatric symptoms. The administration of ketamine to ICU patients with ARDS should be with caution.
TRIAL REGISTRATION
Clinicaltrials.gov: NCT02637011 (Registered 15 December 2015, retrospectively registered).
背景
急性呼吸窘迫综合征（ARDS）是一种危及生命的疾病，有发生缺氧的风险，因此需要进行有创机械通气和长期的镇静镇痛。然而，长期的镇静镇痛可能是导致健康相关生活质量（HRQoL）下降和精神障碍发展的一个原因。
方法
我们使用了德国全国性 ARDS 前瞻性观察研究（DACAPO）的数据，调查了镇静镇痛对 ARDS 幸存者从重症监护病房（ICU）出院后 3、6 和 12 个月的 HRQoL 以及发生精神症状的影响。HRQoL 使用 12 项简短健康调查问卷的身体和精神成分量表（PCS-12，MCS-12）进行测量。使用患者健康问卷-9 和创伤后应激障碍-14 评估精神症状（抑郁和创伤后应激障碍）的患病率。使用多变量线性回归模型来研究镇静镇痛与 HRQoL 和精神症状的相关性。
结果
134 名 ARDS 幸存者（中位数年龄[IQR]：55 [44-64]，67%为男性）的数据显示，在 ICU 出院后 1 年内，镇静镇痛与身体或精神 HRQoL 之间没有任何显著关联。多变量线性回归分析（B [95%CI]）显示，在 ICU 出院后 6 个月内，使用累积剂量的氯胺酮与精神障碍症状之间存在显著关联（3 个月后：抑郁：0.15 [0.05，0.25]；6 个月后：抑郁：0.13 [0.03，0.24]和创伤后应激障碍：0.42 [0.04，0.80]）。
结论
在 ICU 出院后 1 年内，镇静镇痛并未影响 ARDS 幸存者的 HRQoL。然而，在 ICU 治疗期间长期使用氯胺酮与发生精神症状的风险呈正相关。因此，在 ARDS 患者中使用氯胺酮应谨慎。
试验注册
Clinicaltrials.gov：NCT02637011（2015 年 12 月 15 日注册，回溯性注册）。
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