| Objective1 To introduce Richards-Campbell Sleep Questionnaire(RCSQ) and ICU Memory Tool(ICUMT)and translate it into Chinese, to evaluate the reliability and validity of the amended Chinese version of RCSQ and ICUMT, and discuss its applicability in assession for the subjective sleep quality and ICU memory for ICU patients in China.2 To investigate patients’ memories of intensive care unit(ICU) and the influencing factors, and to examine the relationship between ICU memories and ICU sleep quality.3 To analyse the prevalence and risk factors of PTSD in ICU survivors at 6 months after ICU discharge, and provide the reference frame for decreasing PTSD earlier.Methods1 We got the approval of the original authors of RCSQ and ICUMT and translated them into Chinese, back-translated and cross-cultural tested.Outcomes including the content validity, internal consistency reliability and test-retest reliability of the scale.2 A multi-centre follow-up study was used, patients were who had been consecutively admitted to the ICU nearly one year(from Octorber, 2013 to August,2014) in four ICUs from two provincial hospitals in Fuzhou city. Within three days and one week after discharge from the ICU to a regular room, a structured, in-person interview was conducted with each individual patient. All patients were asked to complete RCSQ and ICUMT questionnaires respectively.3 We conducted a multi-centre follow-up study in four ICUs from two provincial hospitals in Fuzhou city, patients were who had been consecutively admitted to the ICUs from Octorber, 2013 to November, 2014. Telephone interviews were conducted within six months after discharge from ICU. All patients were asked to complete the PCL-C、SSRS and SF-36 questionnaire survey. Data analysis was done by the Statistical Package for Social Sciences version 18.0. Chi-square analysis,Spearman correlatedanalysis and logistic regression analysis were used to analyse the influence factors.Results1 Translation and validation the RCSQ and ICUMT(1) RCSQ Chinese version.(1)Reliability: The internal consistency reliability of the scale-Cronbach’s alpha was 0.81 and the test-retest reliability coefficient was 0.77(P﹤0.01).(2)Content validity: The content validity index(CVI) of the scale is computered by Delphi expert consultation, it is 0.83~1.00, the average of CVI was 0.93 for the total. The factor component analysis method was used for exploratory factor analysis.Exploratory factor analysis extracted one common factor eigenvalues greater than 1 that can reflect the 69.72% of the total variance. The correlation coefficient between the each entry scores was 0.37~0.81(P﹤0.01), the correlation coefficient between each entry and the total scores of questionnaires was 0.75~0.86(P﹤0.01).(2) ICUMT Chinese version.(1)Reliability: The Cronbach’s alpha coefficient for the overall scale was 0.80 and 0.62~0.76 for the three dimensions, were factual memories,memories of feelings and delusion memories respectively. The test-retest reliability of three dimensions were 0.69~1.00(P﹤0.01).(2)Content validity: The CVI of the scale was computered by Delphi expert consultation, it was 0.67~1.00, the average of CVI was 0.95 for the total. The factor component analysis method was used for exploratory factor analysis. Exploratory factor analysis extracted seven common factors eigenvalues greater than 1 that can reflect the 63.63% of the total variance.2 ICU memory and the influencing factors(1) ICU memory: Sixty patients(13.2%) had none memory of ICU, 68.7%remembered all the stay clearly. The incidences of memories of factual events,memories of feelings and delusional memories were 91.9%, 72.8% and 29.1%respectively. The most common content of factual memories were voices(67.3%),lights(66.3%) and ward round(64.2%). Uncomfortable(54.5%), pain(45.5%) and feeling anxious/frightened(24.0%) and were the altitude three among memories of feelings. Memory of dearms(21.5%), hallucinations(11.8%) and nightmares(8.3%) were for delusional memories.(2) The influential factors of ICU memory: Patients with mechanical ventilation had more frequencies of factual memories than those without mechanical ventilation(P ﹤0.05). There were significant differences in memories of feelings among different levels of RCSQ(P﹤0.01). Patients whose length of ICU stay were more than5 days had more frequencies of delusional memories(P ﹤ 0.01). The sleep quality was significant influencing factor of memories of feelings(P﹤0.05), length of ICU stay was significant influencing factor of delusional memories(P﹤0.05). Different level scores tested had significant difference, the high scores of RCSQ group had higher incidence of ICU memory(including memories of voices, illumination, discomfort, discomfort, panic,pain and nightmares) than those with low scores of RCSQ(P﹤0.05).3 The incidence of PTSD and the risk factors(1) The incidence of PTSD symptoms The total PCL-C scores in ICU patients was(25.66±8.64) points, with the scores of re-experiencing, avoidance, and hyperarousal dimensions being 7.25±3.28, 9.96±3.69 and 8.50±3.19 respectively. Eighteen subjects(9.52%) were screened PTSD symptom,the rate of re-experience, avoiding numbness and high-alert were 45(23.81%), 19(10.05%) and 45(23.81%) respectively.(2) The risk factors of PTSD symptoms The development of PTSD symptoms was related to memory of feelings and sleep quality(P﹤0.05). PTSD symptoms were negatively correlated with social support(P﹤0.05) and also with health-related quality of life(HRQOL)(P ﹤ 0.01). Health-related quality of life measured by SF-36 in all patients with PTSD symptoms investigated was significantly reduced in all dimensions, physical as well as mental. Results of logistic regression analysis showed that the age, sleep quality and health-related quality of life are the most important influence factors of PTSD(P﹤0.05).Conclusion1 The Chinese version of RCSQ and ICUMT have good reliability and validity.They served as sensible and applicable evaluation instruments for the subjective sleep quality and ICU memory for ICU patients in China.2 Many patients had negative ICU memory. The subjective sleep quality during ICUand length of ICU stay were the main influence factors of ICU memory. ICU staffs should pay close attention to improve sleep quality for ICU patients, to reduce the negative experiences during ICU, and enhance their physical and mental health.3 The incidence of PTSD symptoms was high in ICU patients within six months after discharge from ICU, which were related to age, memory of feelings, sleep quality,social support and health-related quality of life. Age, sleep quality and health-related quality of life were important factors to influence patients’ PTSD symptom. |
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