دليريوم پس از جراحي قلب باز: نقش پريشاني و افسردگي پيش از جراحي در بروز آن

مقدمه: دليريوم يكي از عوارض مهم و شايع پس از جراحي قلب است. هدف: تعيين فراواني دليريوم پس از جراحي قلب در موارد با پريشاني و افسردگي پيش از جراحي. مواد و روش‌ها: اين مطالعه مقطعي تحليلي بر 108 بيمار كانديد جراحي قلب الكتيو مراجعه كننده به بخش جراحي مركز آموزشي درماني دكتر حشمت رشت صورت گرفت. پرسشنامه افسردگي و پريشاني بيمارستاني‌، اضطراب موقعيتي – خصيصه‌اي اشپيلبرگر و پرسشنامه بررسي وضعيت شناختي بيماران پيش از جراحي چك ليست غربالگري دليريوم طي سه روز بعد از آن استفاده شد. داده‌هاي گردآوري شده با آمار توصيفي (توزيع فراواني،ميانگين و انحراف معيار ) و آمار استنباطي (تي مستقل و كاي اسكوير) واكاري شد. ‌ نتايج: بروز دليريوم در سه روز پس از جراحي به طور متوسط 38% گزارش شد. ميانگين سني در موارد با دليريوم تفاوت معني‌داري با گروه بدون دليريوم نداشت. فراواني دليريوم بر پايه گروه‌هاي جنسي‌، تحصيل، شرايط زندگي، تاهل و ابتلاي به ديابت اختلاف معني‌دار نداشت(p > 0/05) ‌اضطراب موقعيتي و خصيصيه‌اي به ترتيب در 72% و 65% از بيماران گزارش شد. فراواني دليريوم در بيماران با اضطراب موقعيتي و خصيصه‌اي، پريشاني و افسردگي بيمارستاني از نظر آماري تفاوت معني‌داري با گروه بدون اين اختلال نداشت (p > 0/05) 31% د‌رصد بيماران در ابتداي مطالعه درجاتي اختلال شناختي خفيف را گزارش كردند كه بروز دليريوم در اين گروه تفاوت معني‌داري با موارد سالم نداشت. نتيجه گيري: به رغم درصد چشمگير پريشاني و افسردگي در همه بيماران پيش از جراحي، بروز دليريوم در اين گروه بيش از موارد بدون اختلال نبود.

Introduction: Postoperative delirium is one the most common and serious complications that patients develop after undergoing cardiac surgery. Objective:The present study aimed To investigate the preoperative anxiety and depression of the patients decided to undergo heart bypass surgery and to examine the relationship between these two factors and the incidence of postoperative delirium in the patients. Materials and Methods: In this cross-sectional research study, as many as 108 patients referred to the surgery department of Heshmat Educational-Therapeutic Center in Rasht, north of Iran, for elective cardiac surgery were targeted. For the purpose of the data collection, the Hospital Anxiety and Depression Scale (HADS), the Speilberger State-Trait Anxiety Inventory(STAI), and the Mini Mental State Examination (MMSE) were distributed among the patients before they undergo the surgery and a Postoperative Delirium Scale (DOS) was given to them three days after the surgery. The data were then analyzed using descriptive statistics (frequency, mean, and standard deviation) and inferential statistics (independent t-test and chi-square). Results: On average, delirium was reported in 38% percent of the patients three days after the surgery. It was also discovered that the average age of the patients with delirium was not significantly different from that of those without delirium. Moreover, the findings indicated that the frequency of experiencing delirium was not significantly different among patients in terms of being diabetic and non-diabetic and in terms of their sex, education, life condition, and marital status. State anxiety and trait anxiety were reported in 72% percent and 65% percent of the patients respectively. The frequency of experiencing delirium by the patients with state-trait anxiety as well as hospital anxiety and depression was not significantly different from that of those without disorders. It was shown that 31% of the patients had reported degrees of minor cognitive disorders before the surgery; the frequency of delirium in this group of the patients was not significantly different from the patients without any psychological disorders. Conclusion: Despite the prevalence of anxiety and depression in the patients before the heart bypass surgery, they did not experience more delirium than the patients without psychological disorders. Conflict of interest: none declared.