ABSTRACT
Abstract Objective: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. Methods: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. Results: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). Conclusion: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Anxiety/physiopathology , Anxiety/drug therapy , Anti-Anxiety Agents/therapeutic use , Preoperative Care/methods , Coronary Artery Bypass, Off-Pump/psychology , Electrocardiography/psychology , Lorazepam/therapeutic use , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/psychology , Reference Values , Time Factors , Reproducibility of Results , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Coronary Artery Bypass, Off-Pump/methodsABSTRACT
Este estudo descritivo e exploratório teve como objetivo examinar as percepções sobre o uso de marca-passo cardíaco permanente. Como estratégia metodológica, utilizou-se o estudo de caso na perspectiva psicanalítica. O corpus de análise foi composto pela estratégia da história de vida focal, operacionalizada por entrevista em profundidade. Foram identificadas as seguintes percepções: choque ao receber o diagnóstico, medo de morrer durante a cirurgia, implante do marca-passo como tábua de salvação, satisfação com o procedimento e preocupação constante dos familiares com o bem-estar da paciente. Os dados sugerem a necessidade de apoio psicológico ao paciente desde o momento do implante do dispositivo cardíaco. Nesse contexto, a escuta qualificada do inconsciente possibilita avançar na compreensão psicodinâmica de seu padecimento.
This descriptive and exploratory study aimed to examine perceptions about the use of permanent cardiac pacemaker. As a methodological strategy, the case study was used in the psychoanalytic perspective. The corpus of analysis was composed by the strategy of the focal life history, operationalized by an in-depth interview. The following perceptions were identified: shock after getting the diagnosis, fear of dying during surgery, implantation of the pacemaker as a lifeline, satisfaction with the procedure, and constant concern of the family with the patient's well-being. The data suggest the need for psychological support to the patient from the moment of implantation of the cardiac device. In this context, the qualified listening of the unconscious allows to advance in the psychodynamic understanding of its suffering.
Este trabajo descriptivo y de exploración tuvo como objetivo examinar las percepciones sobre el uso de marcapasos cardíaco permanente. Como estrategia metodológica se utilizo el estudio de caso, bajo la perspectiva psicoanalítica. El corpus del análisis fue compuesto por la estrategia de la historia de vida focal, llevada a cabo por entrevista en profundidad. Fueron identificadas las siguientes percepciones: choque al recibir el el diagnóstico, miedo de morir en la cirugía, implante del marcapaso como tabla salva-vidas, satisfacción con el procedimiento y preocupación constante de los familiares con el bienestar del paciente. Los datos sugieren la necesidad de apoyo psicológico al paciente desde el momento de la implantación del dispositivo cardíaco. En este contexto, la escucha cualificada del inconsciente posibilita avanzar en la comprensión psico-dinámica de su padecimiento.
Cette étude descriptive exploratoire a l'objectif d'examiner les perceptions quant à l'utilisation d'un stimulateur cardiaque permanent. L'etude de cas, dans la perspective psychanalytique, a été la stratégie méthodologique utilisé. Le corpus d'analyse a été composée par la stratégie de l'histoire de la vie focale, opérationnalisée par des entretiens en profondité. Les idées suivantes ont été identifiés : choc après avoir reçu le diagnostic, la peur de mourir pendant la chirurgie, l'implant de stimulateur cardiaque comme ligne de vie, satisfaction avec la procédure et constante préoccupation de la famille en ce qui concerne le bien-être du patient. Les données suggèrent la nécessité d'un soutien psychologique pour le patient dès le moment de l'implantation du dispositif. Dans ce contexte, l'écoute qualifié de l'inconscient permet d'avancer dans la compréhension psychodynamique de vos souffrances.
Subject(s)
Humans , Patients/psychology , Arrhythmias, Cardiac/psychology , Pacemaker, Artificial , PsychoanalysisABSTRACT
En las últimas décadas, la falla cardiaca se ha convertido en un problema de salud pública y, recientemente, se ha identificado la presencia de sintomatología depresiva en personas que padecen esta patología. El estado de depresión afecta la situación clínica del paciente y su tratamiento, y es más significativo en personas que se encuentran en clase funcional III y IV, puesto que son más susceptibles de presentar descompensaciones, rehospitalización y alteración de la calidad de vida, todo lo cual genera un impacto negativo en la morbilidad y mortalidad. Lo anterior hace necesario que el profesional de enfermería oriente el cuidado hacia la identificación y manejo de la depresión, realizando actividades propias de enfermería o en conjunto con otras disciplinas. El propósito de este artículo de revisión es mostrar el impacto de la depresión, reflejado en la incidencia, efectos fisiológicos, signos y síntomas de la depresión en el paciente con falla cardiaca, y las herramientas necesarias que permitan orientar, mejorar y fortalecer el plan decuidado de enfermería...
In recent decades, heart failure has become a public health problem, and recently, depressivesintomatology has been identified in people suffering heart failure pathology. Depression compromises the patients clinical condition and treatment, this is more significant in people with heart failure functional class III and IV, it generates a negative impact on morbidity and mortality, making them increasingly susceptible to decompensation, impaired quality of life, readmissions and death. Therefore is necessary that professional nursing aimed at care to the identification and management of depression, performing activities of nursing or joint with others disciplines. The purpose of this review article is to show the impact of depression reflected in the incidence, physiological effects, signs and symptoms of depression in patients with heart failure and tools necessary that guide, improve and strengthen the nursing care plan for these patients...
A insuficiência cardíaca tem se tornado, nas últimas décadas como um problema de saúde pública e, recentemente, identificou a presença de sintomas depressivos em pessoas que sofrem desta doença. O estado de depressão compromete a condição clínica do paciente e seu tratamento, é mais significativo em pessoas que estão em classe funcional III e IV, uma vez que eles são mais suscetíveis à descompensação, reinternação e redução da qualidade de vida, gerando um impacto impacto negativo na morbidade e mortalidade. Isso torna necessário que os cuidados de enfermagem para orientar a identificação e gestão das actividades de enfermagem realizando depressão ou em conjunto com outras disciplinas. O objetivo desta revisão é mostrar o impacto da depressãoreflete na incidência, efeitos fisiológicos, os sinais e sintomas de depressão em pacientescom insuficiência cardíaca e ferramentas para orientar, melhorar e reforçar o plano deassistência enfermagem...
Subject(s)
Arrhythmias, Cardiac/psychology , Patients/psychology , Depressive Disorder/nursingABSTRACT
Radiofrequency catheter ablation (RFCA) has been used to treat cardiac arrhythmias in Thailand since 1992. The effect of this procedure on quality of life has not been systematically studied. The purpose of this study was to assess the impact of RFCA on quality of life in patients with cardiac arrhythmias. Data were collected by interviewing 30 patients from February 1998 to August 1998, before and two months after RFCA. The questionnaire used for this study was created by researchers using Zhan's conceptual framework and SF36 in 4 dimensions--life satisfaction, self-concept and psycho-social well being, health functioning and physical well being, socio-economic and social well being. The questionnaire was validated by experts. Its reliability was tested by using Cronbach's test that gave an alpha coefficient of 0.81. Our study showed that the overall quality of life scores 2 months after RFCA (mean = 179.467, SD = 17.005) were higher than before RFCA (mean = 131.567, SD = 18.680). The results also showed a statistically significant difference (p = 0.000). CONCLUSION: It was found that RFCA significantly improved the quality of life of patients with various cardiac arrhythmias. However, this study consisted of a small sample size. Further work in this area with a large sample size is needed to confirm this finding.