Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
Psychosom Med. 2013 Sep;75(7):640-9. doi: 10.1097/PSY.0b013e31829a8c89. Epub 2013 Aug 24.
After the implantation of an implantable cardioverter-defibrillator (ICD), patients often fear therapeutic shock. The extent to which the experience of pre-hospital discharge (PHD) testing without anesthesia after ICD implantation, under observation by a physician, affects shock-related anxiety symptoms on follow-up has not been investigated as yet.
In a prospective, randomized controlled trial, 44 patients with a primary prevention indication for an ICD were randomly assigned to experience PHD testing without anesthesia (n = 23) or with anesthesia (n = 21). Patients were longitudinally evaluated before (T(1)), shortly after (T(2)), and 3 months after (T(3)) PHD testing. During the respective PHD testings, the course of patients' serum cortisol release was measured.
During PHD testing, patients without anesthesia showed a significantly higher serum cortisol release than patients with anesthesia (F(4,152) = 22.227, p < .001). Patients who experienced PHD testing without anesthesia felt significantly safer with the ICD (U = 165.000, p = .040), would significantly more often recommend other patients to undergo PHD testing without anesthesia (χ(2) = 12.013, p = .002), and showed significantly lower levels of general shock-related anxiety shortly afterward (F(1,42) = 6.327, p = .02) and 3 months after PHD testing (F(1,41) = 8.603, p = .005).
The implementation of PHD testing without anesthesia is associated with lower anxiety concerning therapeutic shock. Patients should be advised about the effects of PHD testing without anesthesia on their psychological well-being in the long run.
植入埋藏式心脏复律除颤器（ICD）后，患者常对治疗性电击感到恐惧。植入 ICD 后在医生观察下不进行麻醉进行预出院（PHD）测试，这种测试经历对随访时电击相关焦虑症状的影响尚未被研究。
在一项前瞻性、随机对照试验中，44 名 ICD 一级预防指征的患者被随机分为不进行麻醉（n = 23）或进行麻醉（n = 21）的 PHD 测试。患者在 PHD 测试前（T1）、测试后不久（T2）和 3 个月后（T3）进行纵向评估。在各自的 PHD 测试中，测量患者的血清皮质醇释放情况。
在 PHD 测试期间，未接受麻醉的患者的血清皮质醇释放明显高于接受麻醉的患者（F（4，152）= 22.227，p <.001）。经历过无麻醉 PHD 测试的患者感觉 ICD 更安全（U = 165.000，p =.040），会更倾向于推荐其他患者进行无麻醉 PHD 测试（χ（2）= 12.013，p =.002），而且在测试后不久（F（1，42）= 6.327，p =.02）和 3 个月后（F（1，41）= 8.603，p =.005），他们的电击相关一般焦虑程度明显更低。
实施无麻醉 PHD 测试与较低的电击相关焦虑有关。应告知患者在长期内不进行麻醉的 PHD 测试对其心理健康的影响。
