- 學位論文
接受心臟手術前後病人的失志症候群與憂鬱相關因素探討
An exploration of factors associated with demoralization syndrome and depression in patients undergoing cardiac surgery
摘要
背景：病人在接受心臟手術時，面對疾病本身與手術繼之而來的壓力，可能會導致情緒困擾。在不同心臟疾病診斷別中已發現有相當高之比率的病人會罹患失志症候群，其發生率更勝於憂鬱症，但目前仍缺乏接受冠狀動脈繞道手術與瓣膜手術病人的失志症候群與其相關因素探討之研究。 目的：探討心臟手術前、後病人的失志症候群與憂鬱現象，及其相關因子。 方法：本研究採前後測研究設計法，於南部二家醫學中心心臟血管科病房進行收案，完成前後測問卷者共40人，資料收集時間點為個案手術前一天與出院前一天。 結果：接受心臟手術前病人出現失志情形者有17.5%，手術後有7.5%，手術前、後失志分佈情形達顯著差異；憂鬱情形在手術前則有12.5%，手術後有10%，手術前、後憂鬱改變情形無顯著差異。手術後出現合併症者，其手術後之失志得分顯著較高。在相關性探討上，手術前、後憂鬱與失志呈顯著正相關。在失志症候群之重要預測因子探討上，術前憂鬱為唯一的預測因子，其調整解釋力為42.8%；術後則為憂鬱與婚姻狀況，其調整解釋力為51%。 結論：心臟手術前出現失志情形者高於術後，憂鬱與單身者也較容易有失志現象。本研究結果可提供臨床醫護人員在臨床實務工作中，能儘早發現此問題的存在，進而給予最合適之處置及預防，及未來發展介入性措施研究之參考。
並列摘要
Abstract Background: When patients undergo cardiac surgery, having the disease itself and also the physical stress of the operation can lead to emotional distress. Demoralization syndrome is highly prevalent in patients with different heart disease diagnoses. Its incidence is even higher than that of major depression in these patients. Currently, there is still a lack of research exploring factors influencing the occurrence of demoralization syndrome in patients with coronary artery bypass surgery or valve surgery. Purpose: This study explored the occurence of demoralization syndrome and depression, as well as the predictors of such demoralization in patients undergoing cardiac surgery. Method: The study employed a pretest and posttest research design. A total of 40 participants undergoing cardiac surgery were recruited from cardiovascular wards in two medical centers in southern Taiwan. Baseline data were collected before the cardiac surgery, and the posttest was done at the day before discharge from hospital. Results: Demoralization was identified in 17.5% and 7.5% of patients before and after cardiac surgery, respectively. Demoralization improved significantly after surgery. Depression was identified in 12.5% and 10% of patients before and after cardiac surgery, respectively. This difference was not statistically significant. Where postoperative complications were noted, demoralization scores were significantly higher after surgery. In correlation analyses, depression remained significantly associated with demoralization both before and after surgery. In multiple linear regression analyses, depression score was the only significant predictor of demoralization score before surgery with an adjusted R-square of 42.8%. Depression and marital status were the two critical predictors of demoralization after surgery, accounting for 51% of the variance in demoralization. Conclusion: Before cardiac surgery, demoralization was higher than after surgery. Depression and a single status predicted that patients would be more likely to have demoralization. The results of this study can provide the clinical staff with heightened awareness and a reference point to detect this problem early to develop interventions for managing it better and to prevent demoralization syndrome.
參考文獻
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