Post-traumatic stress disorder after weaning from prolonged mechanical ventilation
Post-traumatic stress disorder after weaning from prolonged mechanical ventilation
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DOI：
10.1007/s00134-010-1972-8
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发表时间：
2010-12-01
影响因子：
38.9
通讯作者：
Tobin, Martin J.
中科院分区：
文献类型：
--
作者：
Jubran, Amal;Lawm, Gerald;Tobin, Martin J.
长时间机械通气脱机可能与精神不适有关。目前尚不清楚这种不适是否与创伤后应激障碍（PTSD）的发展有关。因此，我们调查了是否PTSD发生在患者脱离长期通气后。我们还确定了是否管理问卷调查将识别患者发生PTSD的风险。对转移到长期急性护理医院的患者进行了前瞻性纵向研究，以脱离长期通气：72例患者在脱机后1周进行了研究，41例患者在3个月后再次进行了研究。一位经验丰富的心理学家在断奶后3个月进行了一次结构化的临床访谈，以确定PTSD的诊断。为了评估PTSD相关症状的存在，在撤机后1周和3个月后进行了创伤后应激综合征（PTSS-10）问卷调查。在撤机后3个月，12%的患者被心理学家诊断为PTSD。PTSD患者有精神疾病史的可能性更大（P < 0.02）。撤机后1周PTSS-10评分> 20分者可可靠地识别3个月后诊断为PTSD的患者：敏感性1.0;特异性0.76;受试者工作特征曲线下面积0.91。断奶后一周PTSS-10评分> 20的患者在3个月后被诊断为PTSD。这一发现表明，在出院前进行简单的问卷调查可以识别出有患创伤后应激障碍风险的患者。
Weaning from prolonged mechanical ventilation may be associated with mental discomfort. It is not known whether such discomfort is linked with the development of post-traumatic stress disorder (PTSD). Accordingly, we investigated whether PTSD occurs in patients after weaning from prolonged ventilation. We also determined whether administering a questionnaire would identify patients at risk for developing PTSD.A prospective longitudinal study of patients transferred to a long-term acute-care hospital for weaning from prolonged ventilation was undertaken: 72 patients were studied 1 week after weaning, and 41 patients were studied again 3 months later. An experienced psychologist conducted a structured clinical interview 3 months after weaning to establish a diagnosis of PTSD. To assess for the presence of PTSD-related symptoms, the post-traumatic stress syndrome (PTSS-10) questionnaire was administered 1 week after weaning and 3 months later.The psychologist diagnosed PTSD in 12% of patients 3 months after ventilator weaning. Patients who developed PTSD were more likely to have a previous history of psychiatric disorders (P < 0.02). A PTSS-10 score > 20 one week after weaning reliably identified patients who were diagnosed with PTSD 3 months later: sensitivity 1.0; specificity 0.76; area under the receiver-operating characteristic curve 0.91.PTSD was diagnosed in 12% of patients who were weaned from prolonged ventilation. A PTSS-10 score > 20 one week after weaning identified patients diagnosed with PTSD 3 months later. This finding suggests that a simple questionnaire administered before hospital discharge can identify patients at risk for developing PTSD.