The impact of pain and depression on recovery after coronary artery bypass grafting.
The impact of pain and depression on recovery after coronary artery bypass grafting.
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DOI：
10.1097/psy.0b013e3181e6df90
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发表时间：
2010-09
影响因子：
3.3
通讯作者：
Rollman BL
中科院分区：
文献类型：
--
作者：
Morone NE;Weiner DK;Belnap BH;Karp JF;Mazumdar S;Houck PR;He F;Rollman BL
目的：探讨疼痛与抑郁对冠状动脉旁路移植术(CABG)术后康复的影响。一项对453名CABG术后抑郁和非抑郁患者的二次数据分析，这些患者参加了一项随机、对照、有效的电话协同治疗抑郁症试验。结果测量收集自2004年3月至2007年9月，包括疼痛、身体功能和情绪症状。抑郁症患者(基线患者健康问卷-9分≥10)与非抑郁症患者相比，在基线和冠脉搭桥术后12个月的SF-36躯体疼痛量表上报告的疼痛评分显著更差。在抑郁症患者中，那些接受协作性护理的患者在CABG后2到12个月之间的每个时间点的疼痛评分显著高于随机分为常规护理对照组的抑郁症患者，p<；0.05。无论干预状态如何，在8个月和12个月时，至少有中度疼痛的抑郁症参与者报告的功能状态(由Duke活动状态指数衡量)显著低于没有疼痛或轻度疼痛的抑郁症患者，p<；0.05。在整个随访过程中，至少有中度疼痛的抑郁症患者与疼痛较少或没有疼痛的抑郁症患者相比，抑郁症状改善的可能性要小得多，p<；0.05。这些发现控制了年龄、性别、教育程度、种族、合并症和基线疼痛诊断。抑郁和疼痛似乎影响冠状动脉搭桥术后的功能恢复。临床医生在计划治疗时应考虑这两种情况与12个月结果之间的关系。
To describe the relationship between pain and depression on recovery after coronary artery bypass grafting (CABG). A secondary data analysis on 453 depressed and nondepressed post-CABG patients enrolled in a randomized, controlled, effectiveness trial of telephone-delivered collaborative care for depression. Outcome measures were collected from March 2004 to September 2007 and included pain, physical function, and mood symptoms. Depressed patients (baseline Patient Health Questionnaire-9 score ≥ 10) versus those without depression reported significantly worse pain scores on the SF-36 Bodily Pain Scale at baseline and up to 12-months post-CABG, p < 0.05. Among patients with depression, those who received collaborative care reported significantly better pain scores at each time point between 2 and 12-months post-CABG vs. depressed patients randomized to the usual care control group, p < 0.05. Regardless of intervention status, depressed participants with at least moderate pain at baseline reported significantly lower functional status (measured by the Duke Activity Status Index) at 8 and 12-months vs. depressed patients with none or mild pain, p < 0.05. Depressed patients with at least moderate pain at baseline were also significantly less likely to show improvement of depressive symptoms throughout the course of follow-up vs. depressed patients with little or no pain, p < 0.05. These findings controlled for age, gender, education, race, comorbid conditions and baseline pain diagnosis. Depression and pain appear to influence functional recovery post-CABG. The relationship between these two conditions and 12-month outcomes should be considered by clinicians when planning treatment.