ICU入室患者の集中治療体験とICU退室3ヵ月後の精神的問題の関連：前向き観察研究

The Intensive Care Experience and Psychological Outcomes of Critically Ill Patients Three Months After ICU Discharge: A Prospective Observational Study

要旨

　目的：ICUに入室した患者のICU退室3ヵ月後の精神的問題の実態および集中治療体験と精神的問題の関連を明らかにすること

　方法：ICUに48時間以上在室し，人工呼吸療法を行った成人患者201名に縦断調査を行った．ICU退室早期に集中治療体験，ICU退室3ヵ月後にpost-traumatic stress disorder（PTSD），不安，抑うつ症状を測定した．

　結果：141名が調査を完了した．ICU退室3ヵ月後の臨床上問題となるPTSD，不安，抑うつ症状の有病割合は17.0，19.9，36.9％で，43.3％がいずれかに該当した．集中治療体験は精神的問題との関連を示さず，ICU入室中の不穏，ICU退室早期の不安，抑うつが関連した．

　結論：ICU退室3ヵ月後に40％を超える患者が精神的問題を有する現状が明らかになった．今後は，不穏および鎮静管理と精神的問題の関連の検討が必要である．

　Objective: To investigate and clarify the association between the intensive care experience and the psychological outcomes of ICU survivors 3 months after being discharged from the ICU.

　Methods: The participants were 201 adult patients who were intubated, mechanically ventilated and stayed in an ICU for more than 48 hours. The intensive care experience was measured by the Intensive Care Experience Questionnaire 1-2 weeks after ICU discharge. The psychological outcomes were the prevalence of PTSD-related symptoms, anxiety and depression 3 months after ICU discharge, defined as an Impact of Event Scale-Revised score ≥ 25 and a Hospital Anxiety and Depression Score ≥ 8. Logistic regression analysis was used to identify any association between the intensive care experience and psychological outcomes.

　Results: Of the 201 patients, 141 completed a 3-month follow-up. Substantial PTSD symptoms were prevalent in 17.0% of patients (95% CI 11.2-24.3), anxiety in 19.9% (95% CI 13.6-27.4) and depression in 36.9% (95% CI 28.9-45.4). Overall, 43.3% (95% CI 35.0-51.9) of patients had one or more substantial symptom. The intensive care experience was not found to be associated with psychological outcomes (adjusted OR = 1.30, 95% CI 0.61-2.76), but was associated with agitation, anxiety and depression early ICU discharge.

　Conclusion: In this study, as many as 40% of patients had PTSD-related symptoms, anxiety or depression, singly or in combination, 3 months after being discharged from the ICU. Future studies are needed to clarify the relationship between sedation practice and psychological outcomes after ICU discharge.