Posttraumatic stress disorder in general intensive care unit survivors: a systematic review
Posttraumatic stress disorder in general intensive care unit survivors: a systematic review
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DOI：
10.1016/j.genhosppsych.2008.05.006
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发表时间：
2008-09-01
影响因子：
7
通讯作者：
Bienvenu, O. Joseph
中科院分区：
文献类型：
--
作者：
Davydow, Dimitry S.;Gifford, Jeneen M.;Bienvenu, O. Joseph
目的：我们的目的是总结和严格审查有关普通重症监护室（ICU）幸存者创伤后应激障碍（PTSD）患病率、ICU后PTSD的危险因素以及ICU后PTSD对健康相关生活质量（HRQOL）的影响的数据。方法：采用Medline、EMBASE、Cochrane Library、CINAHL、PsycINFO等系统文献综述，手工检索13种期刊。结果：15项研究符合条件。问卷确定的“临床显著”PTSD症状的中位数患病率为22% (n=1104)，临床诊断的PTSD的中位数患病率为19% （n=93）。ICU后创伤后应激障碍的一致预测因素包括先前的精神病理、ICU内更多的苯二氮卓类药物使用和ICU后对ICU内恐惧和/或精神病经历的记忆。女性性别和年轻年龄是不太一致的预测因素，而危重疾病的严重程度始终不是预测因素。icu后PTSD与较低的HRQOL相关。结论：创伤后应激障碍在ICU存活者中的患病率较高，并对存活者的HRQOL产生负面影响。未来的研究应全面探讨患者特异性因素（如ICU前精神病理）、ICU管理因素（如镇静剂的使用）和ICU临床因素（如ICU内谵妄）之间的关系以及与ICU后PTSD的关系。临床医生在照顾日益增长的ICU幸存者时，应该意识到PTSD的危险因素，并监测患者对早期干预的需求。(C) 2008爱思唯尔公司版权所有。
Objective: Our objective was to summarize and critically review data on the prevalence of posttraumatic stress disorder (PTSD) in general intensive care unit (ICU) survivors, risk factors for post-ICU PTSD and the impact of post-ICU PTSD on health-related quality of life (HRQOL).Methods: We conducted a systematic literature review using Medline, EMBASE, Cochrane Library, CINAHL, PsycINFO and a hand-search of 13 journals.Results: Fifteen studies were eligible. The median point prevalence of questionnaire-ascertained "clinically significant" PTSD symptoms was 22% (n=1104), and the median point prevalence of clinician-diagnosed PTSD was 19% (n=93). Consistent predictors of post-ICU PTSD included prior psychopathology, greater ICU benzodiazepine administration and post-ICU memories of in-ICU frightening and/or psychotic experiences. Female sex and younger age were less consistent predictors, and severity of critical illness was consistently not a predictor. Post-ICU PTSD was associated with substantially lower HRQOL.Conclusions: The prevalence of PTSD in ICU survivors is high and negatively impacts survivors' HRQOL. Future studies should comprehensively address how patient-specific factors (e.g., pre-ICU psychopathology), ICU management factors (e.g., administration of sedatives) and ICU clinical factors (e.g., in-ICU delirium) relate to one another and to post-ICU PTSD. Clinicians caring for the growing population of ICU survivors should be aware of PTSD risk factors and monitor patients' needs for early intervention. (C) 2008 Elsevier Inc. All rights reserved.