Wejner-Mik Paulina, Sobczak Maria, Miskowiec Dawid, Wdowiak-Okrojek Katarzyna, Kasprzak Jaroslaw D, Lipiec Piotr
Department of Cardiology, Medical University of Lodz, Lodz-Poland.
Anatol J Cardiol. 2016 Sep;16(9):684-8. doi: 10.5152/AnatolJCardiol.2015.6514. Epub 2015 Nov 26.
Despite premedication, anxiety in patients undergoing transesophageal echocardiography (TEE) is prevalent, often causing adverse physiological and psychological effects and contributing to decreased patient compliance. We aimed to evaluate the feasibility of cognitive-behavioral intervention (CBI) in patients undergoing TEE and to assess its impact on the severity of anxiety, patient's and physician's comfort, and administered dose of sedatives.
Our study was designed as a prospective, single-center, single-blinded, case-controlled pilot study. The study group comprised 49 patients (26 men, 66±8 years old) referred for TEE. Before the examination, 26 randomly selected patients underwent CBI. Sedatives were administered, if necessary. After the examination, patient anxiety and patient's and physician's comfort were evaluated using dedicated questionnaires and scores. Intergroup comparison was performed using Student's t-test for independent variables and Mann-Whitney U test and Pearson's chi-square test or Fisher's exact test for categorical variables.
The mean level of pre-TEE distress and anxiety were significantly lower in patients receiving CBI than in those without intervention (p=0.022). Furthermore, the application of CBI significantly reduced patient's discomfort (p<0.001) and resulted in increased comfort of physician (p<0.001) during TEE. The need of sedative administration (31% vs. 91%, p<0.001) and its mean dose was significantly lower in patients receiving CBI (1.6±0.5 mg vs. 2.7±1.6 mg midazolam, p=0.009).
CBI is feasible in patients undergoing TEE. It decreases patient's anxiety and discomfort and increases physician's comfort. It also results in reduced use of sedatives during the examination.
尽管进行了术前用药，但接受经食管超声心动图（TEE）检查的患者中焦虑仍然普遍存在，这常常会引起不良的生理和心理影响，并导致患者依从性下降。我们旨在评估认知行为干预（CBI）在接受TEE检查的患者中的可行性，并评估其对焦虑严重程度、患者和医生舒适度以及镇静剂给药剂量的影响。
我们的研究设计为一项前瞻性、单中心、单盲、病例对照的试点研究。研究组包括49例接受TEE检查的患者（26名男性，66±8岁）。检查前，26例随机选择的患者接受了CBI。必要时给予镇静剂。检查后，使用专用问卷和评分对患者焦虑以及患者和医生的舒适度进行评估。对于自变量，采用学生t检验进行组间比较；对于分类变量，采用曼-惠特尼U检验、皮尔逊卡方检验或费舍尔精确检验。
接受CBI的患者在TEE检查前的痛苦和焦虑平均水平显著低于未接受干预的患者（p = 0.022）。此外，CBI的应用在TEE检查期间显著降低了患者的不适感（p < 0.001），并提高了医生的舒适度（p < 0.001）。接受CBI的患者使用镇静剂的需求（31%对91%，p < 0.001）及其平均剂量显著较低（咪达唑仑1.6±0.5 mg对2.7±1.6 mg，p = 0.009）。
CBI在接受TEE检查的患者中是可行的。它降低了患者的焦虑和不适感，提高了医生的舒适度。它还导致检查期间镇静剂的使用减少。
