Six-month neuropsychological outcome of medical intensive care unit patients
Six-month neuropsychological outcome of medical intensive care unit patients
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DOI：
10.1097/01.ccm.0000059996.30263.94
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发表时间：
2003-04-01
影响因子：
8.8
通讯作者：
Ely, EW
中科院分区：
文献类型：
--
作者：
Jackson, JC;Hart, RP;Ely, EW
客观的。旨在检查在重症监护病房接受机械通气的患者出院后 6 个月的神经心理功能、抑郁和生活质量。设计：前瞻性队列研究。环境，大学医疗中心的三级护理、内科和冠心病重症监护病房。研究人群。对来自医疗重症监护病房的连续 275 名连续机械通气患者进行了前瞻性随访。 6 个月时，157 人还活着，其中 41 人（26%）返回进行广泛的随访测试。测量和主要结果。在 6 个月的随访中进行了神经心理学测试以及抑郁症和生活质量的评估。 41 名患者中的 7 名因使用改良 Blessed 痴呆评定量表和医疗记录审查通过替代访谈确定的先前存在的认知障碍而被排除在进一步分析之外。根据规范数据得出的严格标准，我们发现 34 名患者中有 11 名 (32%) 存在神经心理障碍。损伤通常是弥漫性的，但主要发生在精神运动速度、视觉和工作记忆、语言流畅性和视觉构建领域。研究人群中神经心理缺陷的发生率明显高于轻度痴呆的人群标准。出院时 (p = 0.04) 和 6 个月随访时 (p = 0.02)，神经心理受损组的老年抑郁量表简表得分异常程度明显高于未受损组，出院时 27% 的受损受试者和 6 个月随访时 36% 的受损受试者出现临床显着抑郁。通过出院时的简短健康调查 12 或 6 个月的随访进行测量，各组之间的生活质量没有观察到差异。结论：长期神经心理障碍在重症监护病房的幸存者中很常见，并且与相关规范数据相比，其发生频率高于预期。未来的研究有必要阐明危重疾病、神经心理损伤、抑郁和生活质量下降之间关联的本质。
Objective. To examine neuropsychological function, depression, and quality of life 6 months after discharge in patients who received mechanical ventilation in the intensive care unit.Design: Prospective cohort study.Setting., Tertiary care, medical and coronary intensive care unit of a university-based medical center.Study Population., A total of 275 consecutive, mechanically ventilated patients from a medical intensive care unit were prospectively followed. At 6 months, 157 were alive, of whom 41 (26%) returned for extensive follow-up testing..Measurement and Main Results., Neuropsychological testing and assessment of depression and quality of life were performed at 6-month follow-up. Seven of 41 patients were excluded from further analysis due to preexisting cognitive impairment determined via surrogate interviews using the Modified Blessed Dementia Rating Scale and a review of medical records. On the basis of strict criteria derived from normative data, we found that 11 of 34 patients (32%) were neuropsychologically impaired. Impairment was generally diffuse but occurred primarily in areas of psychomotor speed visual and working memory, verbal fluency, and visuo-construction. The rate of neuropsychological deficits in the study population was markedly higher than population norms for mild dementia. Scores on the Geriatric Depression Scale-Short Form were significantly more abnormal in the neuropsychologically impaired group than in the nonimpaired group at hospital discharge (p =.04) and at 6-month follow-up (p =.02), and clinically significant depression was found in 27% of impaired subjects at hospital discharge and in 36% at 6-month follow-up. No differences were observed between groups in quality of life as measured with the Short Form Health Survey-12 at discharge or 6-month follow-up.Conclusions., Prolonged neuropsychological impairment is common among survivors of the medical intensive care unit and occurs with greater than anticipated frequency when compared with relevant normative data. Future investigations are warranted to elucidate the nature of the association between critical illness, neuropsychological impairment, depression, and decreased quality of life.