Anxiety and depression as risk factors for mortality after coronary artery bypass surgery

OBJECTIVE: This retrospective study examined the association between symptoms of depression, anxiety, and mortality risk following coronary artery bypass graft (CABG) surgery. METHODS: We assessed 440 CABG surgery patients' scores on the Depression Anxiety and Stress Scale (DASS) and followed up mortality status for a median of 5 years, 10 months. RESULTS: There were 67 (15%) deaths overall during the follow-up period. Adjusted survival analysis showed that preoperative depressive symptoms were not associated with a significantly higher risk of mortality. Survival analysis with preoperative anxiety adjusted for covariates showed a significantly increased mortality risk [hazard ratio (HR)=1.88 (95% CI=1.12-3.17), P=.02]. CONCLUSION: Preoperative anxiety symptoms were significantly associated with increased mortality risk after adjustment for known mortality risk factors. Future research should further explore the simultaneous role of anxiety and depression on mortality following CABG.     

冠脉搭桥术后严重神经系统并发症的研究

目的 回顾性研究冠状动脉旁路移植术后发生的神经系统并发症,为临床选择治疗方法和评估预后提供依据。方法 将2002年9月至2009年8月我科完成761例CABG术纳入本研究。使用统计学方法揭示神经系统并发症和其危险因素之间的关系。结果 本组41例患者术后有严重神经系统并发症,死亡8例,2例死于术后消化道大出血;1例死于严重感染;4例死于多脏器功能衰竭,1例死于术后癫痫持续发作。存活33例,平均随访3年,死亡3例,3例肢体活动障碍部分恢复,1例有严重智力障碍。结论 高龄患者（>70岁）术后有较高的神经系统并发症发生率,术前颈动脉狭窄、高血压病、糖尿病、大量输血、房颤、高脂血症等为术后发生神经系统并发症的危险因素。与不停跳冠脉搭桥相比,体外循环下搭桥不更具危险性。     

Combining carotid endarterectomy with off-pump coronary artery bypass graft surgery is safe and effective

Background:

We, as neurologists, are frequently consulted to give neurological clearance for surgery in patients who are undergoing coronary artery bypass graft (CABG) surgery and have suffered from stroke or transient ischemic attack (TIA) in past. Similarly clearance is also sought in another group of patients who, though have not suffered from stroke or TIA, but found to have significant carotid stenosis on routine screening prior to surgery. Cardiac surgeons and anesthetists want to know the risk of perioperative stroke in such patients and should carotid endarterectomy (CEA) be done along with CABG. In absence of any clear-cut guideline, neurologists often fail to give any specific recommendation.

Aim:

To find out safety and efficacy of synchronous CEA in patients undergoing CABG.

Design:

Retrospective study.

Materials and Methods:

Out of 3,700 patients who underwent CABG, 150 were found to have severe carotid stenosis of >70%. Out of this, 46 patients with >80% stenosis (three symptomatic and 43 asymptomatic) and one patient with >70% symptomatic carotid stenosis (TIA within last 2 weeks) were taken for simultaneous CEA along with CABG. These three symptomatic carotid patients had suffered from stroke within last 6 months.

Results:

One patient with asymptomatic near total occlusion of carotid artery suffered from hyperperfusion syndrome. None suffered from ischemic stroke, myocardial infarction (MI), or death during perioperative period.

Conclusion:

Combining CEA along with CABG is a safe and effective procedure.     

两种冠状动脉旁路移植术对围术期患者血浆特异性烯醇化酶和S100蛋白的影响

目的探讨体外循环和非体外循环下冠状动脉旁路移植术对围术期血浆特异性烯醇化酶（NSE）、S100蛋白（S100）的影响。方法选取择期行冠状动脉移植术患者50例,随机分为体外循环下手术组和非体外循环下手术组,每组25例。于术前（T1）、术后即刻（T2）、术后6h（T3）、术后24h（T4）和术后48h（T5）抽取血样本,采用放射免疫法检测各时间点血浆中NSE、S100蛋白含量。结果术前NSE、S100蛋白含量组间差异无统计学意义（P〉0.05）,2组术后即刻NSE、S100蛋白浓度均明显升高,但体外组升幅明显大于非体外组,差异有统计学意义（P〈0.05）;体外组和非体外组术后6h浓度开始下降,并延续至24h后,术后48h非体外组基本恢复至术前水平,而体外组尚处于较高水平。结论体外循环和非体外循环冠状动脉旁路移植术均可引起血浆NSE、S100蛋白水平升高,但非体外循环冠状动脉旁路移植术对其影响较小。     

冠状动脉旁路移植术后并发脑损伤的临床分析

目的探讨冠状动脉旁路移植术（CABG）合并心内其他手术后,早期中枢神经系统并发症的发生、种类、危险因素及防治方法。方法回顾分析214例CABG合并心内其他手术后各种中枢神经系统并发症的发生率,按有无脑部症状分成2组,进行单因素比较分析。结果CABG联合其他心内手术后早期并发脑损伤的总发生率18.2%（39/214）,其中表现精神异常14例（6.54%）,表现为脑梗死3例（1.40%）,TIA15例（7.01%）,癫痫5例（2.34%）,短暂性全面遗忘症2例（0.93%）。统计分析发现患者体外循环时间、心肌血流阻断时间与脑损伤发生率有相关性,且并发脑损伤组患者临床观察时间明显延长。结论体外循环时间、心肌血流阻断时间是CABG合并其他心内手术后早期并发脑损伤的相关独立的危险因素。     

A population-based study of the association between coronary artery bypass graft surgery (CABG) and cognitive decline: the Cache County study

BACKGROUND: The relationship between coronary artery bypass graft (CABG) surgery and cognitive decline remains uncertain, in particular with regard to whether there is delayed cognitive decline associated with this procedure. METHODS: This was a population-based cohort study involving participants in the Cache County Study of Memory Health and Aging. At baseline the study enrolled 5,092 persons age 65 and older and followed them up three years later and again four years after that. Individuals who reported having undergone CABG surgery at study baseline or had this surgery in between follow-up waves were compared to individuals who never reported having the surgery. The main outcome measure was the Modified Mini Mental State (3MS). Multilevel models were used to examine the relationship between CABG surgery and cognitive decline over time. RESULTS: Study participants who had CABG surgery evidenced 0.95 points of greater decline relative to baseline on the 3MS at the first follow-up interview after CABG, and an average of 1.9 points of greater decline at the second follow-up interview, than those without CABG (t = -2.51, df = 2,316, p = 0.0121), after adjusting for several covariates, including number of vascular conditions. This decline was restricted to individuals who were more than five years past the procedure and was not evident in the early years after the surgery. CONCLUSIONS: CABG surgery is associated with accelerated cognitive decline more than five years after the procedure in a long-lived population. This decline is small and its clinical significance is uncertain. We could not find an association between CABG and decline in the first five post-operative years.     

局部脑氧饱和度监测在冠脉旁路移值术的应用研究

目的探讨局部脑氧饱和度监测在冠脉旁路移值术(OPCAB)中的应用价值。方法选取2018-02—2019-01在郑州市第七人民医院行OPCAB患者共有291例,均行脑氧监测,且术中尽力维持rSO2≥50%且在基础值的75%以上,称为脑氧组,于术前1 d、术后72 h和术后1周常规填写MMSE量表;选取2017-02—07在郑州市第七人民医院行OPCAB患者126例,术中未行脑氧监测,为非脑氧组,于术前1 d、术后72 h和术后1周常规填写MMSE量表。结果(1)2组患者在年龄、性别、体重指数、左心室收缩功能、高血压和糖尿病的并发症等资料无明显区别(P>0.05),2组患者术前MMSE评分无明显区别(P>0.05)。(2)2组患者术后3 d、7 d、3个月MMSE评分比较,脑氧组均明显高于非脑氧组(P<0.05),2组患者在手术时间、桥血管数量、病死率、脑血管疾病发病率无明显区别(P>0.05)。(3)2组患者在机械通气时间、重症监护时间、住院时间比较,脑氧组明显短于非脑氧组(P<0.05),住院总费用比较,脑氧组明显少于非脑氧组(P<0.05)。(4)脑氧组内根据是否出现POCD,把脑氧组内分为POCD组和非POCD组。POCD组97例中出现rSO2低于正常下限共有41例,占组内42.3%(41/97),非POCD组194例中出现rSO2低于正常下限共有54例,占组内27.8%(54/194)。POCD组内rSO2低于正常下限明显高于非POCD组(P<0.01)。结论在OPCAB中,应常规脑氧监测,尽量同时维持rSO2≥50%和基础值的75%以上,能减少脑部缺血缺氧,降低POCD发生率,缩短治疗周期,改善患者预后。     

Psychological risk factors for cardiac-related hospital readmission within 6 months of coronary artery bypass graft surgery

OBJECTIVE: The objective of this study was to examine the psychological risk factors for cardiac-related readmission within 6 months of coronary artery bypass graft surgery (CABG). METHODS: Consecutive patients awaiting elective CABG (N=119; 100 males and 19 females), with a mean age of 63.3 years, completed a battery of psychosocial measures in a three-stage repeated-measures design. Relevant medical data were also extracted from patients' medical records 6 months postoperatively to allow for the examination of potential covariates. RESULTS: Two psychological variables, increased postoperative anxiety and increased preoperative depression, were identified as risk factors for cardiac-related readmission independent of the only significant covariate identified, cardiopulmonary bypass time. CONCLUSION: Anxiety in the immediate postoperative period and, to a lesser extent, preoperative depression are important determinants of health care utilization postdischarge. Further research to clarify the psychological factors that are predictive of readmission, and that attempt to determine both the underlying cause of readmissions and potential mechanisms through which psychological factors act is recommended. Such research may highlight potential factors to target in interventions and the best time at which to intervene.     

Optimism measured pre-operatively is associated with reduced pain intensity and physical symptom reporting after coronary artery bypass graft surgery

Objective

Optimism is thought to be associated with long-term favourable outcomes for patients undergoing coronary artery bypass graft (CABG) surgery. Our objective was to examine the association between optimism and post-operative pain and physical symptoms in CABG patients.

Methods

We assessed optimism pre-operatively in 197 adults undergoing CABG surgery, and then followed them up 6–8 weeks after the procedure to measure affective pain, pain intensity, and physical symptom reporting directly pertaining to CABG surgery.

Results

Greater optimism measured pre-operatively was significantly associated with lower pain intensity (β = − 0.150, CI = − 0.196 to − 0.004, p = .042) and fewer physical symptoms following surgery (β = − 0.287, CI = − 0.537 to − 0.036, p = .025), but not with affective pain, after controlling for demographic, clinical and behavioural covariates, including negative affectivity.

Conclusions

Optimism is a modest, yet significant, predictor of pain intensity and physical symptom reporting after CABG surgery. Having positive expectations may promote better recovery.     

Sleep-disordered breathing is associated with disturbed cardiac repolarization in patients with a coronary artery bypass graft surgery

BackgroundThe development of malignant ventricular arrhythmias due to abnormal cardiac repolarization is a major complication after coronary artery bypass graft surgery (CABG). Sleep-disordered breathing (SDB) is linked to prolonged cardiac repolarization in non-surgical patients. This study evaluates cardiac repolarization in patients with and without SDB who underwent CABG.Methods100 patients who had received CABG (84% men, age 68 ± 10 years, body-mass-index [BMI] 28.7 ± 4.2 kg/m²) were retrospectively evaluated. Polygraphy was recorded the night before CABG. SDB was defined as an apnea-hypopnea index (AHI) of ≥15/h and differentiated into central (CSA) and obstructive (OSA) sleep apnea. Cardiac repolarization was assessed by means of T-peak-to-end (TpTe) and QTc-intervals and TpTe/QT-ratios derived from 12-lead electrocardiography (ECG).Results37% of patients had SDB, 14% CSA and 23% OSA. Before CABG, patients with CSA and OSA had longer TpTe intervals than those without SDB (TpTe: CSA 100 ± 26 vs. OSA 97 ± 19 vs. no SDB 85 ± 14 ms, p = 0.013). QTc intervals and TpTe/QT ratios differed between the two groups (QTc: 444 ± 54 vs. 462 ± 36 vs. 421 ± 32 ms, p < 0.001; TpTe/QT ratio: 0.24 ± 0.04 vs. 0.23 ± 0.05 vs. 0.21 ± 0.03, p = 0.045). SDB was associated with abnormal cardiac repolarization independent of known risk factors for cardiac arrhythmias, such as age, sex, BMI, N-terminal-pro-brain-natriuretic-peptide (NT-proBNP), and heart failure (TpTe: B-coefficient [95%CI]: 16.0, [7.6–24.3], p < 0.001; QTc: 27.2 [9.3–45.1], p = 0.003; TpTe/QT ratio: 2.9 [1.2–4.6], p < 0.001).ConclusionIndependent of known risk factors for cardiac arrhythmias, SDB was significantly associated with abnormal cardiac repolarization before CABG. Data suggest that SDB may contribute to an increased risk of ventricular arrhythmias after CABG.     

Early postoperative ulnar neuropathies following coronary artery bypass surgery.

Ulnar neuropathies following surgery are common. However, they often go undetected during the early postoperative period, because the patient may be unaware of symptoms related to the neuropathy. Nerve conduction studies are useful in localizing the lesion, but are usually employed only in cases developing signs and symptoms. We undertook this study to determine the incidence, time of onset, and outcome of clinical and subclinical ulnar neuropathies. Electrophysiological studies were carried out preoperatively, immediately following surgery, and 4 to 6 weeks postoperatively in 20 coronary artery bypass patients. Conduction velocity across the elbow was reduced in 3 limbs (8%) postoperatively, all of which were detected immediately following surgery. One patient developed conduction block and weakness in ulnar supplied intrinsic hand muscles. Denervation was seen in 2 cases and, in 1 case (5%), a right brachial plexus injury was clinically evident 5 days following surgery. All newly developing ulnar neuropathies were asymptomatic, with most recovering to their preoperative electrophysiological status at follow-up.     

Direct oral anticoagulants for therapeutic anticoagulation in postoperative pulmonary embolism after meningioma resection

BackgroundAcute postoperative pulmonary embolism (PE) is a dreaded complication with severe mortality rates. Brain tumor patients are at the highest risk for postoperative PE. The juxtaposition of low-molecular-weight heparin (LMWH), vitamin K antagonists (VKA) and direct oral anticoagulation (DOAC) in the treatment of postoperative PE in meningioma patients is largely unexplored.Patients/MethodsThis is a single center observational analysis of meningioma patients who underwent neurosurgical resection with a thoracic CT scan confirmation of postoperative PE. The treatment modality, clinical course and outcome were investigated.ResultsOf 538 meningioma patients operated, 30 (6%) developed acute postoperative PE. After diagnosis, these patients received different long-term anticoagulation regimes. No significant difference in postoperative hemorrhage (p < 0.56), re-operation rate (p < 0.70) or Karnofsky performance scale (KPS) at 3 (p < 0.34) and 12 months (p = 1) were identified, when compared according to the different anticoagulation regimes.ConclusionDOACs were not associated with elevated risk for hemorrhage, recurrent thrombosis or poor outcome when compared with traditional anticoagulation regimes. Prospective randomized trials are necessary to verify the non-inferiority of DOACs for long-term anticoagulation in postoperative pulmonary embolism after meningioma resection.     

血红素氧化酶1基因多态和冠状动脉旁路移植后的炎症反应☆○

背景：血红素氧化酶1是降解血红素生成胆红素、亚铁及一氧化碳过程的限速酶,具有重要的抗炎功能,其启动子部位GT重复序列的多态性可使该基因表达的水平不同,重复序列较短者基因转录活性较高。 目的：观察冠状动脉旁路移植术后炎性标记物白细胞介素6,C-反应蛋白及纤维蛋白原的水平及其相关性,探讨血红素氧化酶1基因变量对它们的影响。 设计、时间及地点：观察性试验,于2003年在英国伦敦大学学院心血管遗传病学中心完成。 对象：220例符合入选条件的行冠状动脉旁路移植术的患者,男179例,女41例,年龄(63.34±9.64)岁。 方法：PCR方法和DNA测序仪分析其血红素氧化酶1基因启动子部位GT重复序列的长短;于手术前及术后6,24,48,72,96,120 h分别测白细胞介素6、C-反应蛋白和纤维蛋白原水平。 主要观察指标：血红素氧化酶1基因启动子部位GT重复序列的长短;手术前及术后不同时间白细胞介素6、C-反应蛋白和纤维蛋白原水平。 结果：术前白细胞介素6水平与C-反应蛋白及纤维蛋白原值显著相关(r=0.48,P < 0.000 1;r=0.41,P < 0.000 1),术后3者均显著升高,白细胞介素6峰质量浓度与C-反应蛋白峰质量浓度显著相关(r=0.34,P =0.000 9),但与纤维蛋白原峰值无明显相关性(r=0.15,P=0.13)。术前C-反应蛋白值在血红素氧化酶1各基因组间存在明显差异,长GT重复序列者比短GT重复序列携带者高[(3.76±0.79),(2.07±0.17) mg/L,P =0.013];术后则各基因型组间水平相似。 结论：炎症标志物的水平间存在相关性,血红素氧化酶1基因多态只与术前的基础C-反应蛋白和纤维蛋白原值有关,提示其可能只影响疾病的慢性炎症状态,从而影响炎性疾病的发生,而非急性炎症反应。     

Neurological outcome in coronary artery surgery with and without cardiomlmonarv bypass

Introduction – The neurological complications of coronary artery surgery with cardiopulmonary bypass (CPB) have been extensively studied, but to our knowledge those without CPB (NCPB) have not been defined. Patients & methods – We prospectively examined 81 patients, before and up to seven days after surgery, to compare the neurological morbidity between patients subjected to coronary artery bypass graft (CABG) surgery with and without CPB. We analyzed demographic variables, risk factors and neurological examination including neuropsychological (NPS) tests using chi-square and non-parametric analysis (Mann-Whitney and Kruskal-Wallis). Results – Forty-eight patients (34M; median age = 62 yrs; median number of grafts = 3 and median total surgery duration = 300 min) operated with CPB and 33 without CPB (23M; median age = 64 yrs; median number of grafts = 2 and median total surgery duration = 240 min) differed only in relation to number of grafts (p = 0.0001) and surgery duration (p = 0.0001). Conclusion – We found no difference in early neurological outcome in patients subjected to CABG with or without CPB.     

An alternative pathway for fibrinolysis is activated in patients who have undergone cardiopulmonary bypass surgery and major abdominal surgery

INTRODUCTION: We conducted this prospective study in order to investigate the hypotheses that an alternative pathway for fibrinolysis is activated in patients who have undergone cardiopulmonary bypass (CPB) surgery and major abdominal surgery and that the levels of fibrin degradation products digested by polymorphonuclear neutrophil elastase (elastase-XDP) and the D-dimer increase in the patients' plasma. MATERIALS AND METHODS: We studied a total of 77 patients who were scheduled to undergo either CPB surgery (36 patients) or major abdominal surgery (41 patients) and then measured the elastase-XDP and D-dimer levels at several time points both during and after the surgeries. The CPB surgery was divided into surgery for aortic dissection (AD) and cardiac surgery. The major abdominal surgery consists of hepatic resection and esophagectomy. RESULTS: The elastase-XDP and D-dimer levels significantly increased in the patients who underwent both CPB surgery and major abdominal surgery. The elastase-XDP levels in AD surgery showed highest values at the end of the CPB, while the levels in the other surgeries reached their peak on the day after the surgery. Statistical difference was seen in the levels of elastase-XDP among the three subgroups undergoing a hepatic resection. While we found significant correlations between the levels of elastase-XDP and D-dimer in patients undergoing CPB surgery and a subsegmentectomy of a cirrhotic liver, the correlation coefficients were markedly low in comparison to those of the other surgeries. CONCLUSIONS: Our findings demonstrated that the elastase-mediated pathway of fibrinolysis is activated to varying degrees depending on the surgery performed. Variations in the correlation coefficients between the levels of elastase-XDP and D-dimer may suggest that elastase-mediated fibrinolysis play a different role from the physiological fibrinolysis mediated by plasmin.     

Plasma activity of individual coagulation factors, hemodilution and blood loss after cardiac surgery: A prospective observational study

Background

Hemodilution and consumption of coagulation factors during cardiopulmonary bypass has been suggested to contribute to bleeding complications after cardiac surgery. The aim was to describe the activity of individual coagulation factors after CABG in relation to hemodilution and postoperative bleeding.

Materials and Methods

Plasma concentrations of fibrinogen and plasma activity of FII, FV, FVII, FVIII, FIX, FX, FXI and FXIII adjusted for hemodilution were analysed in 57 CABG patients before, and 2 h and 24 h after surgery. Postoperative bleeding was registered and correlations to coagulation factor activity were calculated.

Results

Adjusted plasma concentration of fibrinogen (-14 ± 6%), and plasma activity of FII (-9 ± 6%), FV (-13 ± 8%), FX (-13 ± 7%) and FXIII (-9 ± 14%) were reduced two hours after surgery compared to baseline (all p < 0.001). FVII (+ 3 ± 12%, p = 0.34) and FXI (+ 1 ± 19%, p = 0.50) were unchanged, while FVIII (+ 23 ± 44%, p = 0.006) and FIX (+ 23 ± 17%, p < 0.001) increased. Twenty-four hours after surgery fibrinogen (+ 45 ± 27%), FVIII (+ 93 ± 66%) and FIX (+ 33 ± 26%) were all increased (all p < 0.001), while FVII (-37 ± 14%, p < 0.001), FXI (-4 ± 18%, p = 0.02) and FXIII (-6 ± 15%, p = 0.004) were decreased.Median postoperative blood loss was 380 ml/12 h. There were significant inverse correlations between postoperative blood loss and fibrinogen concentration 2 h after surgery (r = -0.33, p = 0.019) and between postoperative blood loss and pre- and postoperative FXIII activity (r = -0.34, p = 0.009 and r = -0.41, p = 0.003, respectively), but not between blood loss and any of the other factors.

Conclusions

There is a marked dissociation in plasma activity of individual coagulation factors after CABG. Plasma concentration of fibrinogen and factor XIII activity correlates inversely to postoperative blood loss after CABG.     

Neuro-ophthalmological complications of coronary artery bypass graft surgery

In a prospective study of neurological complications of coronary bypass surgery, detailed pre- and post-operative bedside ophthalmological evaluation was undertaken in 312 patients. Post-operative neuro-ophthalmological complications developed in 80/312 (25.6%) patients and included: areas of retinal infarction (17.3%); retinal emboli (2.6%); visual field defects (2.6%); reduction of visual acuity (4.5%) and Horner's syndrome (1.3%). Neuro-ophthalmological complications were not observed in a control group of 50 patients undergoing major peripheral vascular surgery. Ten of 75 patients reviewed at 6 months still had detectable neuro-ophthalmological abnormalities, but functional disability occurred only in those with persistent visual field defects. Multivariate analysis revealed that extra-coronary vascular disease, severe and prolonged duration of heart disease prior to operation, and large drop in haemoglobin level during surgery may predispose to neuro-ophthalmological complications.     

左乳内动脉冠状动脉旁路移植患者原位与游离状态的流量测定

背景：左乳内动脉旁路移植以疗效可靠、远期通畅率高而成为冠心病外科治疗的首选和标准技术。但左乳内动脉是否合适行序贯吻合及序贯血管的血流量是否能满足人体需要一直存在争议。 目的：探讨接受非体外循环下左乳内动脉冠状动脉旁路移植患者左乳内动脉原位与游离状态的血流量之间的差别。 方法：选择2008-03/2009-03接受非体外循环下左乳内动脉冠状动脉旁路移植患者56例,术中先游离出左乳内动脉近端一小段无蒂光滑区,待循环稳定后,利用即时血流检测仪先进行左乳内动脉原位血流测定,再将左乳内动脉所有侧支完全离断,在远端离断之前,进行左乳内动脉原位游离状态的流量测定。 结果与结论：56例冠心病患者左乳内动脉主干原位血流明显好于游离状态的主干原位血流[(32.0±5.0),(10.0±1.2) mL/min, P < 0.01],表明左乳内动脉主干血流与其分支数目有关;左乳内动脉具有一定的流量储备,可为冠脉搭桥序贯吻合提供理论依据。 关键词：冠状动脉疾病;乳内动脉;流量测定;器官移植;冠状动脉旁路移植     

Differentiating cognitive impairment from symptoms of anxiety in postcoronary artery bypass grafting encephalopathy: a case report

Post-coronary artery bypass grafting encephalopathy (CABGE) is associated with cognitive decline in a significant number of post-cardiac surgery cases. Patients may experience this condition as a result of being maintained on a heart-lung machine, which is referred to as the “pump”. The pump is used to circulate oxygenated blood during heart or valve surgery and may contribute to complication with oxygen flow to the brain. In some cases, the emotional traumatic effects of CABGE may produce symptoms of anxiety that can often mimic the cognitive decline associated with cardiac bypass and use of the pump. When this is the case, cognitive–behavioral assessment may be useful in helping patients to differentiate symptoms generated by anxiety from those produced by the effects of the pump. A discussion section addresses further implications of such overlapping symptoms and therapeutic strategies for treatment and remediation, along with the potential adverse effects that may occur through psychotherapy.     

延续性护理教育对全机器人冠状动脉搭桥术后患者照顾者焦虑情绪的影响

背景 延续性护理教育相关研究多是以患者的视角,缺少延续性护理教育对患者照顾者影响的研究,而照顾者的护理质量与术后康复状态密切相关。目的 考查延续性护理教育对全机器人冠状动脉搭桥术后患者照顾者焦虑情绪的缓解效应,为改善照顾者焦虑情绪、促进患者康复提供参考。方法 于2021年1月1日-2022年12月31日,纳入在中国人民解放军总医院第一和第六医学中心接受全机器人冠状动脉搭桥术患者的照顾者为研究对象(n=120)。采用系统随机取样方法,将照顾者分为研究组和对照组各60人。患者出院前,所有照顾者均接受常规护理教育。研究组在患者出院后,接受为期4周的延续性护理教育。于患者出院前和出院一个月后,采用焦虑自评量表(SAS)对两组照顾者进行评定。结果 患者出院1个月后,研究组SAS评分低于对照组[(57.77±14.08)分vs.(70.19±13.60)分,t=-4.913,P<0.01],研究组SAS评分≥60分的人数占比低于对照组(41.67%vs. 75.00%,χ²=-13.714,P<0.01)。结论 延续性护理教育可能有助于降低全机器人冠状动脉搭桥术后...