School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK.
Int J Nurs Stud. 2012 Feb;49(2):129-37. doi: 10.1016/j.ijnurstu.2011.08.008. Epub 2011 Sep 22.
Patients awaiting cardiac surgery typically experience significant physical and psychological stress. However, although there is evidence that preoperative education interventions can lead to positive postoperative outcomes for surgical patients in general, less is known about the effectiveness among patients undergoing cardiac surgery, especially Chinese cardiac patients.
To determine whether a preoperative education intervention designed for Chinese cardiac patients can reduce anxiety and improve recovery.
Randomized controlled trial.
Cardiac surgical wards of two public hospitals in Luoyang, China.
153 adult patients undergoing cardiac surgery were randomized into the trial, 77 to a usual care control group and 76 to preoperative education group comprising usual care plus an information leaflet and verbal advice. Measurement was conducted before randomization and at seven days following surgery. The primary outcome was change in anxiety measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes were change in depression (HADS), change in pain as measured by subscales of the Brief Pain Inventory-short form (BPI-sf), length of Intensive Care Unit stay and postoperative hospital stay.
Of 153 participants randomized, 135 (88.2%) completed the trial. Participants who received preoperative education experienced a greater decrease in anxiety score (mean difference -3.6 points, 95% confidence interval -4.62 to -2.57; P<0.001) and a greater decrease in depression score (mean difference -2.1 points, 95% CI -3.19 to -0.92; P<0.001) compared with those who did not. There was no difference between groups in average pain, current pain, and interference in general activity, mood and walking ability. Patients randomized to the preoperative education group reported less interference from pain in sleeping (mean difference -0.9 points, 95% CI -1.63 to -0.16; P=0.02). There was some evidence to suggest a reduced number of hours spent in the Intensive Care Unit among preoperative education patients (P=0.05) but no difference in length of postoperative hospital stay (P=0.17).
This form of preoperative education is effective in reducing anxiety and depression among Chinese cardiac surgery patients. Based upon existing evidence and international practice, preoperative education should be incorporated into routine practice to prepare Chinese cardiac patients for surgery.
等待心脏手术的患者通常会经历显著的身心压力。然而，尽管有证据表明术前教育干预措施通常可以为外科患者带来积极的术后结果，但在心脏手术患者，尤其是中国心脏患者中，其效果知之甚少。
确定专为中国心脏患者设计的术前教育干预措施是否可以减轻焦虑并促进康复。
随机对照试验。
中国洛阳两家公立医院的心脏外科病房。
将 153 名成年心脏手术患者随机分为试验组，77 名患者纳入常规护理对照组，76 名患者纳入术前教育组，包括常规护理加信息手册和口头建议。测量在随机分组前和手术后 7 天进行。主要结局是采用医院焦虑抑郁量表（HADS）测量的焦虑变化。次要结局为抑郁变化（HADS）、简明疼痛量表短表（BPI-sf）各亚量表测量的疼痛变化、重症监护病房入住时间和术后住院时间。
在 153 名随机患者中，有 135 名（88.2%）完成了试验。与未接受术前教育的患者相比，接受术前教育的患者焦虑评分下降更多（平均差异-3.6 分，95%置信区间-4.62 至-2.57；P<0.001），抑郁评分下降更多（平均差异-2.1 分，95%置信区间-3.19 至-0.92；P<0.001）。两组患者的平均疼痛、当前疼痛以及对一般活动、情绪和行走能力的干扰均无差异。随机分组至术前教育组的患者报告疼痛对睡眠的干扰更小（平均差异-0.9 分，95%置信区间-1.63 至-0.16；P=0.02）。有证据表明术前教育患者在重症监护病房的时间有所减少（P=0.05），但术后住院时间无差异（P=0.17）。
这种形式的术前教育可有效减轻中国心脏手术患者的焦虑和抑郁。基于现有证据和国际实践，术前教育应纳入常规实践，以为中国心脏患者手术做好准备。
