Predictors of posttraumatic stress and quality of life in family members of chronically critically ill patients after intensive care.
Predictors of posttraumatic stress and quality of life in family members of chronically critically ill patients after intensive care.
复制标题
DOI：
10.1186/s13613-016-0174-0
复制
发表时间：
2016-12
影响因子：
8.1
通讯作者：
Petrowski K
中科院分区：
文献类型：
--
作者：
Wintermann GB;Weidner K;Strauß B;Rosendahl J;Petrowski K
急性医疗条件下延长机械通气会增加慢性危重症（CCI）的风险。CCI患者的亲密家庭成员面临着危及生命的状况，并且容易发展为影响其健康相关生活质量的创伤后应激障碍（HRQL）。本研究的主要目的是调查CCI患者家庭成员创伤后应激和HRQL下降的患者和家庭相关危险因素。在前瞻性纵向队列研究中嵌套的横断面设计中，评估了CCI患者的家庭成员（n = 83，年龄在18至72岁之间）从急性护理医院的ICU转到急性后康复后6个月的创伤后应激症状和生活质量。患者入住一家大型康复医院进行呼吸机脱机治疗。通过电话访谈对患者及其家属进行创伤后应激量表-10和欧洲生活质量5d - 3l。显著比例的CCI患者及其家庭成员（分别为14.5%和15.7%）显示创伤后应激临床相关评分。CCI患者及其家属报告的HRQL均低于标准样本。与家庭成员创伤后应激独立相关的因素是ICU出院后的时间（β = 0.256, 95%可信区间为0.053 -）。470)和患者PTSD的诊断（β = .264, 95%可信区间为.045 ~ .453）。对家庭关系的感知满意度是CCI患者家庭成员创伤后应激的保护因素（β =−）。231,95%置信区间−。423至- 0.015)。家属HRQL方面，ICU患者急性创伤后应激(β =−。290, 95%置信区间−。360 ~−。088)和他们自己的创伤后应激转移后3至6个月(β =−。622, 95%置信区间−。640 ~−。358)被证明是重要的预测因子。创伤后应激和HRQL应在CCI患者的家庭成员中定期进行评估，从ICU早期开始。需要以家庭为中心的预防性干预措施来改善患者及其家庭成员的创伤后应激和HRQL。本文的在线版本（doi:10.1186/s13613-016-0174-0）包含补充材料，可供授权用户使用。
Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053–.470) and the patients’ diagnosis of PTSD (β = .264, 95 % confidence interval .045–.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = −.231, 95 % confidence interval −.423 to −.015). Regarding HRQL in family members, patients’ acute posttraumatic stress at ICU (β = −.290, 95 % confidence interval −.360 to −.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = −.622, 95 % confidence interval −.640 to −.358) turned out to be significant predictors. Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members. The online version of this article (doi:10.1186/s13613-016-0174-0) contains supplementary material, which is available to authorized users.