تأثير برنامه راه انداختن زودهنگام بر ميزان افسردگي بيماران مبتلا به انفاركتوس ميوكارد بستري در بخش CCU

Effects of early mobilization program on depression of patients with myocardial infarction hospitalized in CCU

ﺳﺎﺑﻘﻪ و ﻫﺪف: ﺑﯿﻤﺎري اﻧﻔﺎرﮐﺘﻮس ﻣﯿﻮﮐﺎرد ﯾﮑﯽ از ﺷﺎﯾﻊ ﺗﺮﯾﻦ ﻋﻠﺖ ﻣﺮگ و ﻣﯿـﺮ در ﺟﻬـﺎن ﻣـﯽﺑﺎﺷـﺪ، اﻧﻔـﺎرﮐﺘﻮس ﻣﯿﻮﮐﺎرد ﺑﻪ ﻋﻠﺖ ﺑﺮوز ﻋﻮارض ﻣﺘﻌﺪد و ﻣﺤﺪود ﮐﺮدن ﻓﻌﺎﻟﯿﺖ ﺟﺴﻤﯽ و ﻧﺎﺗﻮاﻧﯽ، ﺳﺒﺐ ﺑﺮوز درﺟﺎت ﻣﺨﺘﻠﻔﯽ از اﻓﺴﺮدﮔﯽ در ﺑﯿﻤﺎران ﻣﯽ ﺷﻮد. ﺗﺤﻘﯿﻖ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺗﻌﯿﯿﻦ ﺗﺄﺛﯿﺮ ﺑﺮﻧﺎﻣﻪ راه اﻧﺪاﺧﺘﻦ زودﻫﻨﮕﺎم ﺑﺮ ﻣﯿﺰان اﻓﺴﺮدﮔﯽ ﺑﯿﻤﺎران ﻣﺒـﺘﻼ ﺑﻪ اﻧﻔﺎرﮐﺘﻮس ﻣﯿﻮﮐﺎرد ﺑﺴﺘﺮي در ﺑﺨﺶ ﻣﺮاﻗﺒﺖ وﯾﮋه ﻗﻠﺒﯽ (CCU) ﻃﺮاﺣﯽ ﺷﺪه اﺳﺖ. ﻣﻮاد و روش ﻫﺎ: اﯾﻦ ﺗﺤﻘﯿﻖ ﯾﮏ ﮐﺎرآزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ ﺑﻮده ﮐﻪ ﺑﺮ روي 38 ﺑﯿﻤﺎر ﻣﺒﺘﻼ ﺑﻪ اﻧﻔﺎرﮐﺘﻮس ﻣﯿﻮﮐـﺎرد در ﺑﺨـﺶ CCU ﺑﯿﻤﺎرﺳﺘﺎن ﺷﻬﯿﺪ ﺑﻬﺸﺘﯽ ﺑﺎﺑﻞ اﻧﺠﺎم ﮔﺮدﯾﺪ. ﻧﻤﻮﻧﻪ ﻫﺎ ﺑﻪ روش ﻧﻤﻮﻧﻪ ﮔﯿﺮي ﻫﺪﻓﻤﻨﺪ اﻧﺘﺨـﺎب ﺷـﺪﻧﺪ و ﺑـﻪ ﺻـﻮرت ﺗﺨﺼﯿﺺ ﺗﺼﺎدﻓﯽ در دو ﮔﺮوه آزﻣﻮن و ﮐﻨﺘﺮل ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﮔﺮوه آزﻣﻮن ﻃﯽ 18-12 ﺳﺎﻋﺖ ﭘﺲ از ﺑﺴﺘﺮي، ﺑـﺮ اﺳـﺎس ﯾﮏ ﺑﺮﻧﺎﻣﻪ ﻣﺸﺨﺺ از ﺑﺴﺘﺮ ﺧﺎرج ﺷﺪﻧﺪ. ﮔﺮوه ﮐﻨﺘﺮل ﺑﺮ اﺳﺎس ﺑﺮﻧﺎﻣﻪ ﻣﺮاﻗﺒﺘﯽ روﺗﯿﻦ ﯾﻌﻨﯽ ﭘﺲ از 48 ﺳﺎﻋﺖ از زﻣـﺎن ﺑﺴﺘﺮي از ﺑﺴﺘﺮ ﺧﺎرج ﺷﺪﻧﺪ. اﻓﺴﺮدﮔﯽ ﺑﯿﻤﺎران ﺑﺎ اﺳﺘﻔﺎده از ﭘﺮﺳﺶ ﻧﺎﻣﻪ اﻓﺴﺮدﮔﯽ ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ (HADS) در ﻃـﯽ 18- 12 ﺳﺎﻋﺖ اول ﭘﺬﯾﺮش (ﻗﺒﻞ ﻣﺪاﺧﻠﻪ) و 72 ﺳﺎﻋﺖ ﭘﺲ از ﭘﺬﯾﺮش (ﺑﻌﺪ ﻣﺪاﺧﻠﻪ) ﺳﻨﺠﯿﺪه ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ ﺳﻄﺢ اﻓﺴﺮدﮔﯽ ﺑﻌﺪ از ﻣﺪاﺧﻠﻪ (روز ﺳﻮم) در ﮔﺮوه آزﻣﻮن 3/2 و در ﮔﺮوه ﮐﻨﺘﺮل 8/2 ﺑﻮد. ﻧﺘـﺎﯾﺞ آزﻣﻮن T ﻣﺴﺘﻘﻞ ﻧﺸﺎن داد ﮐﻪ ﺳﻄﺢ اﻓﺴﺮدﮔﯽ ﺑﻌﺪ از ﻣﺪاﺧﻠﻪ دو ﮔﺮوه داراي ﺗﻔﺎوت ﻣﻌﻨﯽ داري ﺑﻮد (0/001>P). ﻧﺘﯿﺠﻪ ﮔﯿﺮي: ﻧﺘﺎﯾﺞ اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داد ﮐﻪ ﺑﺮﻧﺎﻣﻪ راه اﻧﺪاﺧﺘﻦ زودﻫﻨﮕﺎم در ﮐﺎﻫﺶ اﻓﺴﺮدﮔﯽ ﺑﯿﻤﺎران ﻣـﻮﺛﺮ ﺑـﻮده اﺳﺖ، ﻟﺬا اﺳﺘﻔﺎده از اﯾﻦ راه ﮐﺎر در ﺑﺮﻧﺎﻣﻪ درﻣﺎن و ﻣﺮاﻗﺒﺖ ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ اﻧﻔﺎرﮐﺘﻮس ﻣﯿﻮﮐﺎرد ﺣﺎد ﭘﯿﺸﻨﻬﺎد ﻣﯽﺷﻮد.

Introduction: Myocardial infarction (MI) is the most common causes of mortality in the world. Due to multiple complications and limiting physical activity and disability, myocardial infarction can cause varying degrees of depression in patients. This study was performed to determine the effect of patients early mobilization program on the depression of patients with MI hospitalized in CCU. Materials and Methods: This study was a clinical trial that was performed on 38 patients with myocardial infarction in the cardiac care unit of Babol Shahid Beheshti hospital. Samples were selected using purposive sampling and are randomly allocated into experimental and control groups. The test group got out of bed based on a specific program within 12-18 hours after admission. The control group got out of bed based on routine care program within 48 hours after admission. Patients' depression was measured by Hospital Depression Scale (HADS) within 18-12 hours of admission (pre-intervention) and 72 hours after admission (post-intervention). Results: The mean level of depression after the intervention (day three) was in the test group 3.2 and in the control group 8.2. Mann-Whitney test results showed that there was a significant difference (P<0.001) between the level of depression post intervention in two group. Conclusion: Results of the study showed that early mobilization was effective to reduce patients depression, therefore the use of this approach is suggested in the treatment and care program of patients with acute myocardial infarction.