{"id":16893,"date":"2019-02-24T05:11:39","date_gmt":"2019-02-23T21:11:39","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=16893"},"modified":"2019-06-02T06:33:18","modified_gmt":"2019-06-01T22:33:18","slug":"jama%e5%9c%a8%e7%ba%bf%e5%8f%91%e8%a1%a8-4","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=16893","title":{"rendered":"[JAMA\u6700\u65b0\u53d1\u8868]\uff1a\u62a4\u58eb\u6307\u5bfc\u7684\u9884\u9632\u6027\u5fc3\u7406\u5e72\u9884\u63aa\u65bd\u5bf9\u5371\u91cd\u75c5\u60a3\u8005PTSD\u75c7\u72b6\u4e25\u91cd\u7a0b\u5ea6\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation | February 18, 2019<\/h3>\n\n\n\n

Effect of a Nurse-Led Preventive Psychological Intervention on Symptoms of Posttraumatic Stress Disorder Among Critically Ill Patients: A Randomized Clinical Trial<\/h1>\n\n\n\n

Dorothy M. Wade, Paul R. Mouncey, Alvin Richards-Belle, et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>2019;321(7):665-675. doi:10.1001\/jama.2019.0073<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Importance<\/strong> \u80cc\u666f<\/h2>\n\n\n\n

A meta-analysis of outcomes during the 6 months after intensive care unit (ICU) discharge indicate a prevalence for clinically important posttraumatic stress disorder (PTSD) symptoms of 25%.<\/p>\n\n\n\n

\u5bf9\u4e8eICU\u60a3\u8005\u8f6c\u51fa\u540e6\u4e2a\u6708\u9884\u540e\u7684meta\u5206\u6790\u663e\u793a\uff0c\u6709\u4e34\u5e8a\u91cd\u8981\u610f\u4e49\u7684\u521b\u4f24\u540e\u5e94\u6fc0\u969c\u788d(PTSD)\u53d1\u751f\u7387\u7ea6\u4e3a25%\u3002<\/p>\n\n\n\n

Objective<\/strong>  \u76ee\u7684<\/h2>\n\n\n\n

To determine whether a nurse-led preventive, complex psychological intervention, initiated in the ICU, reduces patient-reported PTSD symptom severity at 6 months.<\/p>\n\n\n\n

\u786e\u5b9a\u7531\u62a4\u58eb\u6307\u5bfc\u7684\u9884\u9632\u6027\u7efc\u5408\u5fc3\u7406\u5e72\u9884\uff08\u4eceICU\u5f00\u59cb\uff09\u80fd\u5426\u964d\u4f4e6\u4e2a\u6708\u65f6\u60a3\u8005\u62a5\u544a\u7684PTSD\u75c7\u72b6\u4e25\u91cd\u7a0b\u5ea6\u3002<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong> \u8bbe\u8ba1\uff0c\u573a\u666f\u53ca\u7814\u7a76\u4eba\u7fa4<\/h2>\n\n\n\n

A multicenter, parallel-group, cluster-randomized clinical trial with integrated economic and process evaluations conducted in 24 ICUs in the United Kingdom. Participants were critically ill patients who regained mental capacity following receipt of level 3 (intensive) care. A total of 2961 eligible patients were identified from September 2015 to January 2017. A total of 2048 were approached for participation in the ICU, of which 1458 provided informed consent. Follow-up was completed December 2017.<\/p>\n\n\n\n

\u82f1\u56fd24\u4e2aICU\u8fdb\u884c\u7684\u4e00\u9879\u591a\u4e2d\u5fc3\u3001\u5e73\u884c\u5206\u7ec4\u3001\u7fa4\u7ec4\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u5bf9\u7ecf\u6d4e\u4e0e\u8fc7\u7a0b\u6307\u6807\u8fdb\u884c\u7efc\u5408\u8bc4\u4f30\u3002\u7814\u7a76\u4eba\u7fa4\u4e3a\u63a5\u53d7ICU\u6cbb\u7597\u540e\u610f\u8bc6\u80fd\u529b\u6062\u590d\u7684\u5371\u91cd\u75c5\u60a3\u8005\u30022015\u5e749\u6708\u81f32017\u5e741\u6708\u5171\u7b5b\u9009\u5408\u683c\u60a3\u80052961\u540d\u30022048\u540d\u60a3\u8005\u5728ICU\u671f\u95f4\u5c31\u53c2\u52a0\u4e34\u5e8a\u8bd5\u9a8c\u5f81\u6c42\u610f\u89c1\uff0c\u5176\u4e2d1458\u540d\u7b7e\u7f72\u77e5\u60c5\u540c\u610f\u30022017\u5e7412\u6708\u5b8c\u6210\u968f\u8bbf\u3002<\/p>\n\n\n\n

Interventions<\/strong> \u5e72\u9884\u63aa\u65bd<\/h2>\n\n\n\n

Twenty four ICUs were randomized 1:1 to the intervention or control group. Intervention ICUs (n\u2009=\u200912; 669 participants) delivered usual care during a baseline period followed by an intervention period. The preventive, complex psychological intervention comprised promotion of a therapeutic ICU environment plus 3 stress support sessions and a relaxation and recovery program delivered by trained ICU nurses to high-risk (acutely stressed) patients. Control ICUs (n\u2009=\u200912; 789 participants) delivered usual care in both baseline and intervention periods.<\/p>\n\n\n\n

24\u4e2aICU\u6309\u71671:1\u7684\u6bd4\u4f8b\u968f\u673a\u5206\u4e3a\u5e72\u9884\u7ec4\u6216\u5bf9\u7167\u7ec4\u3002\u5e72\u9884\u7ec4ICU\uff08n\u2009=\u200912\uff1b669\u540d\u60a3\u8005\uff09\u5728\u57fa\u7ebf\u9636\u6bb5\u8fdb\u884c\u5e38\u89c4\u6cbb\u7597\uff0c\u6b64\u540e\u4e3a\u5e72\u9884\u9636\u6bb5\u3002\u9884\u9632\u6027\u7efc\u5408\u5fc3\u7406\u5e72\u9884\u63aa\u65bd\u5305\u62ec\u6539\u8fdbICU\u6cbb\u7597\u73af\u5883\uff0c\u5e76\u7531\u7ecf\u8fc7\u57f9\u8bad\u7684ICU\u62a4\u58eb\u5bf9\u9ad8\u5371\uff08\u6025\u6027\u5e94\u6fc0\uff09\u60a3\u8005\u8fdb\u884c3\u6b21\u5e94\u6fc0\u652f\u6301\u57f9\u8bad\u53ca1\u6b21\u653e\u677e\u548c\u6062\u590d\u8bfe\u7a0b\u3002\u5bf9\u7167\u7ec4ICU\uff08n\u2009=\u200912\uff1b789\u540d\u60a3\u8005\uff09\u5728\u57fa\u7ebf\u53ca\u5e72\u9884\u9636\u6bb5\u53ea\u8fdb\u884c\u5e38\u89c4\u6cbb\u7597\u3002<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong> \u4e3b\u8981\u9884\u540e\u7ec8\u70b9<\/p>\n\n\n\n

The primary clinical outcome was PTSD symptom severity among survivors at 6 months measured using the PTSD Symptom Scale\u2013Self-Report questionnaire (score range, 0-51, with higher scores indicating greater symptom severity; the minimal clinically important difference was considered to be 4.2 points).<\/p>\n\n\n\n

\u4e3b\u8981\u4e34\u5e8a\u9884\u540e\u7ec8\u70b9\u4e3a6\u4e2a\u6708\u5b58\u6d3b\u8005PTSD\u75c7\u72b6\u7684\u4e25\u91cd\u7a0b\u5ea6\uff0c\u91c7\u7528PTSD\u75c7\u72b6\u91cf\u8868\u2014\u81ea\u6211\u62a5\u544a\u95ee\u5377\u8fdb\u884c\u8bc4\u4f30\uff08\u8bc4\u5206\u8303\u56f40-51\uff0c\u5206\u503c\u8d8a\u9ad8\u63d0\u793a\u75c7\u72b6\u8d8a\u4e25\u91cd\uff1b\u5177\u6709\u4e34\u5e8a\u610f\u4e49\u7684\u6700\u5c0f\u5dee\u5f02\u4e3a4.2\u5206\uff09\u3002<\/p>\n\n\n\n

Results<\/strong>  \u7ed3\u679c<\/h2>\n\n\n\n

Among 1458 enrolled patients (mean [SD] age, 58 [16] years; 599 women [41%]), 1353 (93%) completed the study and were included in the final analysis. At 6 months, the mean PTSD Symptom Scale\u2013Self-Report questionnaire score in intervention ICUs was 11.8 (baseline period) compared with 11.5 (intervention period) (difference, \u22120.40 [95% CI, \u22122.46 to 1.67]) and in control ICUs, 10.1 (baseline period) compared with 10.2 (intervention period) (difference, 0.06 [95% CI, \u22121.74 to 1.85]) between periods. There was no significant difference in PTSD symptom severity at 6 months (treatment effect estimate [difference in differences] of \u22120.03 [95% CI, \u22122.58 to 2.52]; P<\/em>\u2009=\u2009.98).<\/p>\n\n\n\n

\u5171\u5165\u90091458\u540d\u60a3\u8005\uff08\u5e73\u5747[SD]\u5e74\u9f84\uff0c58 [16]\u5c81\uff1b599\u540d\u5973\u6027[41%]\uff09\uff0c\u5176\u4e2d1353 \u540d\u60a3\u8005(93%)\u5b8c\u6210\u7814\u7a76\uff0c\u7eb3\u5165\u6700\u540e\u5206\u6790\u30026\u4e2a\u6708\u65f6\uff0c\u5e72\u9884\u7ec4ICU\u5e73\u5747PTSD\u75c7\u72b6\u91cf\u8868\u2013\u81ea\u6211\u62a5\u544a\u95ee\u5377\u8bc4\u5206\u4e3a11.8\u5206\uff08\u57fa\u7ebf\u9636\u6bb5\uff09\u548c11.5\u5206\uff08\u5e72\u9884\u9636\u6bb5\uff09\uff08\u5dee\u5f02\uff0c\u22120.40 [95% CI, \u22122.46 to 1.67]\uff09\uff0c\u5bf9\u7167\u7ec4ICU\u5206\u522b\u4e3a10.1\u5206\uff08\u57fa\u7ebf\u9636\u6bb5\uff09\u548c10.2\u5206\uff08\u5e72\u9884\u9636\u6bb5\uff09\uff08\u5dee\u5f02\uff0c0.06 [95% CI, \u22121.74 to 1.85]\uff09\u30026\u4e2a\u6708\u65f6PTSD\u75c7\u72b6\u4e25\u91cd\u7a0b\u5ea6\u65e0\u663e\u8457\u5dee\u5f02\uff08\u7597\u6548\u8bc4\u4f30[\u5dee\u5f02\u5dee\u503c] \u22120.03 [95% CI, \u22122.58 to 2.52]; P<\/em>\u2009=\u2009.98)\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong> \u7ed3\u8bba\u4e0e\u610f\u4e49<\/h2>\n\n\n\n

Among critically ill patients in the ICU, a nurse-led preventive, complex psychological intervention did not significantly reduce patient-reported PTSD symptom severity at 6 months. These findings do not support the use of this psychological intervention.<\/p>\n\n\n\n

\u5bf9\u4e8eICU\u7684\u5371\u91cd\u75c5\u60a3\u8005\uff0c\u7531\u62a4\u58eb\u6307\u5bfc\u7684\u9884\u9632\u6027\u7efc\u5408\u5fc3\u7406\u5e72\u9884\u63aa\u65bd\u4e0d\u80fd\u663e\u8457\u964d\u4f4e6\u4e2a\u6708\u65f6\u60a3\u8005\u62a5\u544aPTSD\u75c7\u72b6\u4e25\u91cd\u7a0b\u5ea6\u3002\u8fd9\u4e9b\u53d1\u73b0\u4e0d\u652f\u6301\u4f7f\u7528\u8fd9\u4e00\u5fc3\u7406\u5e72\u9884\u63aa\u65bd\u3002<\/p>\n\n\n\n

Trial Registration<\/strong>  ISRCTN53448131<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation | February 18, 20 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16893"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16893"}],"version-history":[{"count":4,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16893\/revisions"}],"predecessor-version":[{"id":16897,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16893\/revisions\/16897"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16893"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16893"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16893"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}