急重症病人之焦慮、憂鬱與創傷後壓力症候群

Anxiety, Depression, and Posttraumatic Stress Disorders in Critically Ill Patients

急重症病人在照護期間經常暴露在壓力下，造成生理與心理上的影響。心理常見的障礙為憂鬱、焦慮，與創傷後壓力異常，這些問題經常持續數週、數月，甚至數年。病人的焦慮程度與其使用強心劑或血管增壓劑有顯著相關，而憂鬱程度與病人的性別、住院天數、呼吸器或鎮定劑的使用、以及先前存在的憂鬱症有關連。在創傷後壓力異常方面，則與病人的年齡、性別及疾病嚴重性有關。健康照護提供者應提供安全舒適的環境以及可被信賴的專業照護能力，以減緩病人的焦慮與憂鬱；更重要的是，連續性照護可強化病人的安全感，促進調適。鼓勵重要他人的探視、增進舒適、提供急重症單位的日誌協助填補記憶上的缺口，皆已證實可減緩急重症病人創傷後壓力異常的健康問題。此外，病人主要照護者的心理壓力也是健康照護提供者應注意的另一個重要議題，提供足夠的訊息滿足主要照護者的訊息需求，增強其控制感，並協助採取積極因應措施，皆可緩解主要照護者的壓力與照護負擔。

The stresses that often occur in the intensive care units (ICUs) affect critically ill patients physically and psychologically. The common psychological disorders associated with these stresses are anxiety, depression, and post-traumatic stress disorders (PTSDs), which may last for several weeks, months, or even years. The anxiety levels of critically ill patients have been found to be significantly related to the use of inotropes or vasopressors, while depression has been associated with gender, days of hospitalization, use of mechanical ventilation and sedation, as well as preexisting depression. The evidence also proved that age, gender, and severity of illness are related to the development of post-traumatic stress disorders (PTSDs). To help patients' anxiety and depression, the healthcare providers should provide a safe and comfortable environment and possess reliable professional abilities for patients. More importantly, the continuity of nursing care is related to the promotion of patients' feelings of safety and the adaptation enhancement. Encouraging the presence of significant others, increasing comfort levels, and using ICU diaries in filling memory gaps, are all proved to be beneficial for the symptom relief of patients suffering PTSD. Another issue that healthcare providers should focus on is reducing the psychological distress perceived by caregivers. Providing adequate information in satisfying caregivers' need for information, enhancing their sense of control, and helping them use active coping strategies, may alleviate caregiver-perceived stresses and burdens.