探討接受心臟手術病患於術後三個月追蹤期間憂鬱症狀的改變及其相關影響因素

Abstract

摘要 背景：罹患心臟血管疾病需要接受心臟手術的病患，有憂鬱的比例15%~47%，而當中約有一半其憂鬱症狀會持續至一年。許多研究也發現術前有憂鬱會增加心臟手術後2倍的死亡風險。而目前對於探討心臟手術前後病患憂鬱的改變和其影響因素的研究仍不足，導致欲發展憂鬱症的介入照護措施於此族群缺乏相關的實證資料。 目的：1.了解病患於接受心臟手術後第7至14天與術後第三個月憂鬱症狀的變化。2.了解病患於接受心臟手術術後第7至14天以及術後三個月影響憂鬱症狀的因素，包含人口學、疾病與治療因素(手術方式、慢性疾病、術前憂鬱症診斷、術前與術後抗憂鬱症藥物服用、術後藥物服用)、健康行為(生活型態規律性、睡眠總時間、久坐時間、身體活動總量)、情緒調節(認知重評、情感壓抑)與憂鬱症狀程度。 方法：本研究以縱貫性研究設計，對於年滿20歲以上接受心臟手術的病患，分別於手術後第7至14天與手術後第三個月，以結構式問卷收集人口學因子、疾病與治療因子、健康行為評估表、國際身體活動量表-短版(IPAQ-S)、情緒調節量表(ERQ)及貝氏憂鬱量表-II(BDI-II)問卷。IPAQ-S分為三等級：輕度、中度、重度活動量；情緒調節量表分為兩部分：認知重評、情感壓抑；貝氏憂鬱量表第II版本篩檢憂鬱程度分為四等級：正常、輕微、中度、重度。 結果：憂鬱症狀的總分，從手術後7~14天分數至手術後三個月沒有顯著差異，術後7~14天有達到臨床憂鬱症狀為11.7%，術後三個月有達到臨床憂鬱症狀為15.5%。大部分病患的憂鬱總分未達臨床憂鬱程度。手術後7~14天重大壓力事件對於憂鬱症狀程度的預測力達到邊緣的顯著(p=0.05)，表示接受心臟手術兩年內有經歷重大壓力事件者於手術後7~14天可能會傾向較高的憂鬱程度。接受心臟手術後第7~14天至術後三個月有顯著改變的包含睡眠總時間、身體活動總量、久坐的時間、認知重評。病患於手術後隨著時間在睡眠總時間有增加的現象，身體活動量是越增加的，久坐的時間有減少現象。在情緒調節方面表示病患在手術後三個月增加使用認知重評的技巧去調節情緒，而情感壓抑的調節方法在術後三個月則無明顯的差異。影響從術後三個月憂鬱症狀總分的主要預測因子為年齡與身體活動總量。當年紀愈輕以及身體活動總量愈少，憂鬱症狀總分越高。 結論：影響接受心臟手術後第7~14天憂鬱症狀的潛在預測因子為手術前兩年內有重大壓力事件發生；術後第三個月長時間影響憂鬱症狀的主要預測因子為年齡與身體活動總量。未來可對於上述預測因子發展適合於接受心臟手術病患的憂鬱症照護。

Background: There were 15%~47% suffering from depression among the patients with cardiovascular disorders who received cardiac surgery. About 50% of these patients continually suffered from depression for one year. The previous studies found that the past history of depression increased two times of risk for mortality after cardiac surgery. However, there is a lack of study examining the changes of depression status and their associated factors, which influences professionals to develop an effective depression program for the patients who receive cardiac surgery. Objective: This study aimed to examine (1) the changes of depressive symptoms from7-14 days to 3 months after cardiac surgery and (2) their associated factors among the patients with cardiovascular disorders who received cardiac surgery during the 3-month follow up period. The potential predictors included demographic data, disease & treatment factors (such as types of surgery, chronic disease, past history of depression), health behavior (regular lifestyle, total sleep hours, time of sedentary, physical activity), emotional regulation styles (cognitive reappraisal and suppression). Methods: This study adopted a longitudinal design. The inclusion criteria of the participants were aged 20 years and above, and received cardiac surgery. The longitudinal data are collected at two time points: baseline assessment: 7 to 14 days after cardiac surgery and the 3th month after baseline. The structured questionnaires included International Physical Activity Questionnaire (IPAQ-S), Emotion Regulation Questionnaire (ERQ), the Beck Depression Inventory (BDI-II). Results: There were no significant changes in BDI scores from 7-14 days to 3 months after cardiac surgery. Scores of BDI in clinical depression level (>13 scores) were 11.7% and 15.5% of the participants in 7-14 days after cardiac surgery and 3 months. Majority of the participants did not appear to have clinical depression. Life stress events predicting depression at 7-14 days after cardiac surgery achieved the borderline significance (p=0.05).Patients with life stress events within two years before cardiac surgery appeared to have higher levels of depression. There were significant changes from 7-14 days to 3 months after cardiac surgery including longer total sleep hours, higher levels of physical activities, shorter time of sedentary, and higher levels of cognitive reappraisal style of emotional regulation.The main predictors of the depressive symptoms during 3-month follow ups were age and levels of physical activities. High levels of depression were ssociated with younger age and lower levels of physical activities. Conclusions: The potential predictor of depressive symptoms at 7-14 days after cardiac surgery is life stress events. The main predictors of depressive symptoms during 3-month follow ups are age and levels of physical activities.Future depression can be developed by targeting at these predictors for the patients who receive cardiac surgery.