تأثير ماساژ درماني بر افسردگي، استرس و اضطراب بعد از عمل بيماران تحت جراحي پيوند عروق كرونر

The Effectiveness of Massage Therapy on Depression, Anxiety and Stress of Patients after Coronary Artery Bypass Graft Surgery

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺑﺴﻴﺎﺭﻱ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﭘﺲ ﺍﺯ ﺟﺮﺍﺣﻲ ﻗﻠﺐ ﺑﻪ ﻋﻠﺖ ﺍﺳﺘﺮﺱ ﭘﺲ ﺍﺯ ﺟﺮﺍﺣﻲ، ﺑﺎ ﺍﺿﻄﺮﺍﺏ ﻭ ﺍﻓﺴﺮﺩﮔﻲ ﻣﻮﺍﺟﻪ ﻣﻲ ﺷﻮﻧﺪ ﮐﻪ ﺍﻳﻦ ﻣﻮﺿﻮﻉ ﺑﺮ ﮐﻴﻔﻴﺖ ﺯﻧﺪﮔﻲ ﺑﻴﻤﺎﺭﺍﻥ ﻭ ﺩﺭ ﻧﺘﻴﺠﻪ ﭘﻴﮕﻴﺮﻱ ﺭﻭﻧﺪ ﺩﺭﻣﺎﻧﻲ ﺗﺄﺛﻴﺮ ﺳﻮﺋﻲ ﺩﺍﺭﺩ، ﺍﺯ ﺍﻳﻦ ﺭﻭ ﻫﺪﻑ ﺍﺯ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻌﻴﻴﻦ ﺗﺄﺛﻴﺮ ﻣﺎﺳﺎﮊ ﺩﺭﻣﺎﻧﻲ ﺑﺮ ﺍﻓﺴﺮﺩﮔﻲ، ﺍﺳﺘﺮﺱ ﻭ ﺍﺿﻄﺮﺍﺏ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺑﻴﻤﺎﺭﺍﻥ ﺗﺤﺖ ﺟﺮﺍﺣﻲ ﭘﻴﻮﻧﺪ ﻋﺮﻭﻕ ﮐﺮﻭﻧﺮ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻳﮏ ﮐﺎﺭﺁﺯﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ ﺍﺳﺖ. ﺷﺮﮐﺖ ﮐﻨﻨﺪﮔﺎﻥ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺷﺎﻣﻞ 72 ﺑﻴﻤﺎﺭ ﻭﺍﺟﺪ ﻣﻌﻴﺎﺭﻫﺎﻱ ﻭﺭﻭﺩ ﺑﻮﺩﻧﺪ ﮐﻪ ﺍﺯ ﻣﻴﺎﻥ 165 ﺑﻴﻤﺎﺭ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺑﺎﻱ ﭘﺎﺱ ﻋﺮﻭﻕ ﮐﺮﻭﻧﺮ ﻣﺮﺍﺟﻌﻪ ﮐﻨﻨﺪﻩ ﺑﻪ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺷﻬﻴﺪ ﭼﻤﺮﺍﻥ ﺷﻬﺮ ﺍﺻﻔﻬﺎﻥ، ﺩﺭ ﻣﺤﺪﻭﺩﻩ ﺯﻣﺎﻧﻲ 1389/10/1 ﺗﺎ 1390/2/31 ﺍﻧﺘﺨﺎﺏ ﺷﺪﻧﺪ ﻭ ﺳﭙﺲ ﺑﻄﻮﺭ ﺗﺼﺎﺩﻓﻲ ﺩﺭ ﺩﻭ ﮔﺮﻭﻩ ﺁﺯﻣﻮﻥ ﻭ ﺷﺎﻫﺪ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﺑﻴﻤﺎﺭﺍﻥ ﮔﺮﻭﻩ ﺁﺯﻣﻮﻥ36 ﻧﻔﺮ( ﻣﺎﺳﺎﮊ ﺍﺳﺘﺮﻭﮎ ﺳﻄﺤﯽ ﺑﻪ ﻣﺪﺕ 20 ﺩﻗﻴﻘﻪ ﻭ ﺑﻪ ﻣﺪﺕ 12 ﺟﻠﺴﻪ ﻫﻔﺘﻪ ﺍﻱ 3 ﺟﻠﺴﻪ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺩﺭﻳﺎﻓﺖ ﮐﺮﺩﻧﺪ ﻭ ﺑﻴﻤﺎﺭﺍﻥ ﮔﺮﻭﻩ ﺷﺎﻫﺪ ﺗﻨﻬﺎ ﻣﺮﺍﻗﺒﺖ ﻫﺎﻱ ﺭﻭﺗﻴﻦ ﺭﺍ ﺩﺭﻳﺎﻓﺖ ﮐﺮﺩﻧﺪ. ﺍﻓﺴﺮﺩﮔﻲ، ﺍﺿﻄﺮﺍﺏ ﻭ ﺍﺳﺘﺮﺱ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺮ ﺍﺳﺎﺱ ﭘﺮﺳﺸﻨﺎﻣﻪ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ [Depression Anxiety Stress Scale 42 (DASS 42 ﻗﺒﻞ ﺍﺯ ﺍﻧﺠﺎﻡ ﻣـﺪﺍﺧﻠﻪ ﻭ ﺩﺭ ﺭﻭﺯ ﺁﺧﺮ ﻣـﺪﺍﺧﻠﻪ ﻣـﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﮔـﺮﻓﺖ. ﺑﺮﺍﻱ ﺗﺠـﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﺍﻃﻼﻋـﺎﺕ ﺍﺯ ﻧﺮﻡ ﺍﻓﺰﺍﺭ 18 SPSS ﻭ ﺭﻭﺵ ﻫﺎﻱ ﺁﻣﺎﺭﻱ ﺗﻮﺻﻴﻔﻲ ﻭ ﺍﺳﺘﻨﺒﺎﻃﻲ )ﺗﻲ ﻣﺴﺘﻘﻞ، ﺗﻲ ﺯﻭﺝ، ﮐﺎﻱ ﺍﺳﮑـﻮﺋﺮ( ﺍﺳﺘﻔـﺎﺩﻩ ﮔﺮﺩﻳﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻗﺒﻞ ﺍﺯ ﻣﺪﺍﺧﻠﻪ ﻣﻴﺎﻧﮕﻴﻦ )ﺍﻧﺤﺮﺍﻑ ﻣﻌﻴﺎﺭ( ﻧﻤﺮﺍﺕ ﺍﻓﺴﺮﺩﮔﻲ، ﺍﺿﻄﺮﺍﺏ ﻭ ﺍﺳﺘﺮﺱ ﺩﺭ ﮔﺮﻭﻩ ﺁﺯﻣﻮﻥ ﻭ ﺷﺎﻫﺪ ﺩﺭ ﻣﻮﺭﺩ ﺍﻓﺴﺮﺩﮔﻲ ﺑﻪ ﺗﺮﺗﻴﺐ )21/6(6/6 ﻭ )24/1 (6/2، ﺩﺭ ﻣﻮﺭﺩ ﺍﺿﻄﺮﺍﺏ ﺑﻪ ﺗﺮﺗﻴﺐ )14/4(6/6 ﻭ18/5 (8/4 ﻭ ﺩﺭ ﻣﻮﺭﺩ ﺍﺳﺘﺮﺱ ﺑﻪ ﺗﺮﺗﻴﺐ )25(6/5 ﻭ )27/8 (8/4 ﺑﻮﺩ ﮐﻪ ﺗﻔﺎﻭﺕ ﺁﻣﺎﺭﻱ ﻣﻌﻨﻲ ﺩﺍﺭﻱ ﺭﺍ ﻧﺸﺎﻥ ﻧﻤﻲ ﺩﻫﺪ )0/05> P(. ﭘﺲ ﺍﺯ ﻣﺪﺍﺧﻠﻪ ﻣﻴﺎﻧﮕﻴﻦ )ﺍﻧﺤﺮﺍﻑ ﻣﻌﻴﺎﺭ( ﻧﻤﺮﺍﺕ ﺍﻓﺴﺮﺩﮔﻲ، ﺍﺿﻄﺮﺍﺏ ﻭ ﺍﺳﺘﺮﺱ ﺩﺭ ﮔﺮﻭﻩ ﺁﺯﻣﻮﻥ ﻭ ﺷﺎﻫﺪ ﺩﺭ ﻣﻮﺭﺩ ﺍﻓﺴﺮﺩﮔﻲ ﺑﻪ ﺗﺮﺗﻴﺐ )12/6(7/1 ﻭ )23/9(6/5، ﺩﺭ ﻣﻮﺭﺩ ﺍﺿﻄﺮﺍﺏ ﺑﻪ ﺗﺮﺗﻴﺐ )8/2(4/9 ﻭ17/9(8/7 ﻭ ﺩﺭ ﻣﻮﺭﺩ ﺍﺳﺘﺮﺱ ﺑﻪ ﺗﺮﺗﻴﺐ )14/2(8 ﻭ )27/3 (8/3ﺑﻮﺩ ﮐﻪ ﻣﺆﻳﺪ ﺗﻔﺎﻭﺕ ﻣﻌﻨﺎﺩﺍﺭ ﺑﻮﺩ )0/001

Introduction & Objective: Many of the patients after cardiac surgery have anxiety and depression due to surgical stress and this has a negative effect on their quality of life and follow-up their treatment protocol. Thus, the aim of this study was to determine the effectiveness of massage therapy on Depression, Anxiety and stress of patients after coronary artery bypass surgery. Materials & Methods: This was a clinical trial study. In this study 72 patients (from 165 patients), who were underwent coronary artery bypass surgery were selected. This study was performed in the period of December 2010 up to May 2011 in Isfahan's Chamran hospital. Then, the patients were randomly assigned to the two case and control groups. The patients of the case group (n= 36) received Light Pressure Stroking massage for 20 minutes in 12 sessions in 4 consecutive weeks after the surgery. The patients in control group received only the routine care. The patient's depression, anxiety and stress were measured before and after the intervention with DASS 42 Questionnaire. SPSS software, version 18, and descriptive and inferential statistical methods were used for data analysis. Results: Mean (SD) scores for depression, anxiety and stress before the intervention in the case group were 21.6 (6.6), 14.4 (6.6) and 25 (6.5) and in the control group were 24.1 (6.2), 18.5 (8.4) and 27.8 (8.4) respectively; that did not show a significant difference (P > 0.05). After the intervention, scores for depression, anxiety and stress in the case group, were 12.6 (7.1), 8.2 (4.9) and 14.2 (8) and in the control group were 23.9(6.8), 17.9 (8.7) and 27.3 (8.3) respectively; that showed a significant difference (P <0.001). Conclusions: The use of massage therapy can decrease depression, anxiety and stress of patients after coronary artery bypass surgery and due to its low cost and simplicity, it can perhaps be used as a complement to drug therapy and postoperative interventions used in these patients.