在接受机械通风的患者中,ICU日记对创伤后应激障碍症状的影响:随机临床试验
Maité Garrouste-Orgeas1,2,3, Cécile Flahault4, Isabelle Vinatier5
1Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France.
JAMA
|July 17, 2019
概括
在机械呼吸后,ICU日记没有显著减少创伤后应激障碍 (PTSD) 的症状. 这项研究表明,ICU日记在预防PTSD症状方面可能没有效果.
科学领域:
- 危急护理医学
- 心理创伤学
- 健康心理学
背景情况:
- 在重症监护室 (ICU) 住院可能会导致心理困扰,包括创伤后应激障碍 (PTSD).
- 由临床医生和家人维护的ICU日记是缓解这些心理后果的潜在干预措施.
- 之前的研究表明,ICU日记可能有助于减轻PTSD症状.
研究的目的:
- 评估ICU日记在ICU住院患者中减少显著PTSD症状的有效性.
- 评估ICU日记对患者及其家属其他心理结果的影响,如焦虑和抑郁.
主要方法:
- 一个多中心,评估者盲目的随机临床试验,涉及657名接受机械呼吸的成年患者.
- 患者被随机分为接受ICU日记 (干预组) 或常规ICU护理 (对照组).
- 主要结果是显著的PTSD症状,使用影响事件尺度修订 (IES- R) 在急症室出院3个月后进行评估.
主要成果:
- 干预组 (29. 9%) 和对照组 (34. 3%) 在3个月后没有明显的PTSD症状发生率差异 (风险差异, - 4%;P=. 39).
- 两组的IES-R中位数也可以比较.
- 对于预先指定的任何次要结果,包括焦虑,抑郁和患者对ICU停留的记忆,都没有发现显著差异.
结论:
- 在ICU接受机械呼吸治疗的患者中,使用临床医生和家属填写的ICU日记并没有显著减少PTSD症状.
- 这些发现不支持常规使用ICU日记作为预防PTSD症状的策略.
- 可能需要进一步的研究来探讨在ICU住院后心理恢复的替代性或辅助性干预措施.
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