Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany.
Department of Cardiovascular and Thoracic Surgery, University Medical Centre Göttingen, Göttingen, Germany.
Eur J Cardiothorac Surg. 2022 Jun 15;62(1). doi: 10.1093/ejcts/ezac041.
Patients undergoing coronary artery bypass graft (CABG) surgery are exposed to multiple treatment-related stressors, which can impact coping and health-related quality of life (HRQoL). The objective of this trial was to analyse the feasibility and preliminary efficacy of a multi-component intervention that combines psychological support and reduction of hospital-specific stressors on HRQoL, length of hospital and intensive care unit stay, self-efficacy, and plasma interleukin (IL)-6 and -8 levels in CABG patients.
This three-arm, randomized controlled, single-centre pilot trial assessed the Intervention for CABG to Optimize Patient Experience in 88 patients undergoing elective CABG. Standard medical care (SMC, n = 29) was compared with 2 intervention groups: (i) psychological interventions to optimize treatment expectations (IA group, n = 30) and (ii) multi-component intervention (IB group, n = 29) with psychological interventions plus an additional treatment package (light therapy, noise reduction, music, and if desired, 360° images delivered via virtual reality).
The implementation of psychological interventions in routine medical treatment was feasible (91.5% of participants completed all intervention sessions). Both interventions were associated with significantly shorter hospital stay compared to SMC (IA/IB 9.8/9.3 days vs SMC 12.5 days). Self-efficacy expectations at post-surgery were significantly higher compared to SMC both in the IA group (P = 0.011) and marginally in the IB group (P = 0.051). However, there were no treatment effects of the interventions on HRQoL and plasma levels of IL-6 or IL-8 after CABG.
A perioperative multi-component intervention may lead to shorter hospital stay and higher self-efficacy after CABG. Further studies are needed to determine its impact on HRQoL and inflammation.
Ethical approval (# 21/2/18) for the study was obtained from the Research Ethics Committee of the University of Göttingen Medical Center, and the trial was registered in the German Clinical Trials Register (DRKS00015309, https://www.drks.de/drks_web/setLocale_EN.do).
接受冠状动脉旁路移植术 (CABG) 的患者会受到多种与治疗相关的应激源的影响，这可能会影响应对能力和与健康相关的生活质量 (HRQoL)。本试验的目的是分析一种多成分干预措施的可行性和初步疗效，该措施结合心理支持和减少医院特定应激源对 CABG 患者的 HRQoL、住院时间和重症监护病房停留时间、自我效能以及血浆白细胞介素 (IL)-6 和 -8 水平的影响。
这项三臂、随机对照、单中心试验评估了对 88 例择期 CABG 患者进行的 CABG 以优化患者体验的干预措施。标准医疗护理 (SMC，n=29) 与 2 个干预组进行比较：（i）优化治疗预期的心理干预 (IA 组，n=30) 和（ii）多成分干预 (IB 组，n=29)，后者包括心理干预和附加的治疗包（光疗、降噪、音乐，如果需要，通过虚拟现实提供 360°图像）。
在常规医疗中实施心理干预是可行的（91.5%的参与者完成了所有干预课程）。与 SMC 相比，两种干预措施都与住院时间明显缩短相关（IA/IB 9.8/9.3 天 vs SMC 12.5 天）。IA 组（P=0.011）和 IB 组（P=0.051）在手术后的自我效能预期均显著高于 SMC。然而，两种干预措施对 CABG 后 HRQoL 和 IL-6 或 IL-8 血浆水平均无治疗作用。
围手术期多成分干预可能导致 CABG 后住院时间缩短和自我效能提高。需要进一步的研究来确定其对 HRQoL 和炎症的影响。
该研究的伦理批准（#21/2/18）获得了哥廷根大学医学中心研究伦理委员会的批准，该试验在德国临床试验注册处（DRKS00015309，https://www.drks.de/drks_web/setLocale_EN.do）注册。
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