Enhancing Recovery After Cardiac Surgery

促进心脏手术后的康复

• 批准号: 7228814
• 负责人: Lynn Valerie Doering
• 金额: $ 50.17万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-22 至 2009-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7228814
• 关键词: Adherence; Adult; Affect; Age; American; Anti-Inflammatory Agents; Anti-inflammatory; Antidepressive Agents; Arterial Fatty Streak; Atherosclerosis; Biological; Biological Markers; Blood Vessels; Blood specimen; Build-it; C-reactive protein; Cardiac; Cardiac Surgery procedures; Cardiopulmonary Bypass; Caring; Cell Adhesion; Cell Adhesion Molecules; Clinical; Coagulation Process; Coenzyme A; Cognitive Therapy; Communities; Coronary Arteriosclerosis; Coronary Artery Bypass; Cytokine Network Pathway; Data; Depressed mood; Development; Discipline of Nursing; Elevation; Event; Fatigue; Gender; Health; Health Care Costs; Healthcare; Hepatic; Hospitals; Immune system; Incidence; Individual; Inflammation; Inflammatory; Intercellular Adhesion Molecules; Intercellular adhesion molecule 1; Interleukin 6 Receptor; Interleukin-6; Interleukins; Intervention; Linear Models; Linear Regressions; Link; Major Depressive Disorder; Measures; Mediating; Medical; Mental Depression; Modeling; Morbidity - disease rate; Nurses; Operative Surgical Procedures; Outcome; Oxidoreductase; Patients; Physiological; Pilot Projects; Plasma; Play; Population; Postoperative Complications; Postoperative Period; Procedures; Process; Production; Property; Protein C; Randomized; Range; Rate; Recommendation; Recovery; Reporting; Research; Research Personnel; Risk; Role; Rupture; Screening procedure; Sleeplessness; Structure; Syndrome; System; Testing; Thinking; Time; Week; Work; base; clinically significant; cytokine; depressive symptoms; design; follow-up; hospital readmission; immune function; inhibitor/antagonist; mortality; programs; receptor; size; success

DESCRIPTION (provided by applicant): Depression affects approximately 18.8 million adults annually. In patients recovering from coronary artery bypass graft (CABG) surgery, high rates of depression have been reported and depression is associated with increased morbidity and mortality. Recent discoveries show that depression involves changes in proinflammatory cytokines and inflammatory markers that are also implicated in progressive coronary artery disease (CAD) and its complications. This proposed research is based on the hypothesis that the proinflammatory cytokine network is one physiological system that mediates depression with possible clinical significance for CABG patients. It builds upon a conceptual model linking depression, Proinflammatory cytokines, inflammatory markers, and upon initial work regarding the efficacy of cognitive behavioral therapy (CBT) in CABG patients. CBT is a structured intervention based on identification and reframing of negative thoughts that has substantially reduced the incidence of major depression in pilot studies. In this study, the biological mechanisms of CBT will be evaluated by testing its effects on proinflammatory cytokines (interleukin [IL]-6 and its soluble receptor [slL-6r]) and inflammation markers (C-reactive protein [CRP] and soluble intercellular adhesion molecule a [slCAM-1]). CABG patients are an ideal population in which to examine the biological mechanisms of CBT because 1) the procedure is so pervasive, 2) rates of postoperative depression are high, 3) depression is associated with poorer clinical outcomes, and 4) progressive CAD is the major cause of morbidity and mortality in these patients. The aims of the study are to evaluate the effects of CBT on the indicated biological markers, evaluate the temporal correlations between depressive symptoms and biological markers in patients receiving CBT, and describe the relationship of changes in depressive symptoms to changes in biological markers and treatment. A 2-group randomized experimental pretest-posttest design is proposed. After screening, 114 patients with major depression will be randomized to usual nursing and medical care or 8 weeks of nurse-led CBT plus usual care. Blood sampling will occur 1 month and 3 months after hospital discharge. Data will be analyzed using hierarchical linear models and stepwise linear regression, controlling for the effects of demographic and clinical variables including age, gender antidepressant use, statin use, and cardiopulmonary bypass time.

描述（由申请人提供）：抑郁症每年影响大约1880万成年人。在冠状动脉旁路移植术（CABG）恢复期的患者中，抑郁症的发生率很高，抑郁症与发病率和死亡率增加有关。最近的发现表明，抑郁症涉及促炎细胞因子和炎症标记物的变化，这些细胞因子和炎症标记物也与进行性冠状动脉疾病（CAD）及其并发症有关。这项研究基于这样一个假设，即促炎细胞因子网络是一个生理系统，它介导了CABG患者可能具有临床意义的抑郁症。它建立在一个概念模型，抑郁症，促炎细胞因子，炎症标志物，并在关于认知行为疗法（CBT）在冠状动脉旁路移植术患者的疗效初步工作。CBT是一种基于识别和重构消极思想的结构化干预，在试点研究中大大降低了重度抑郁症的发病率。在本研究中，CBT的生物学机制将通过测试其对促炎细胞因子（白细胞介素[IL]-6及其可溶性受体[sIL-6 r]）和炎症标志物（C-反应蛋白[CRP]和可溶性细胞间粘附分子a [sICAM-1]）的影响来评估。CABG患者是检查CBT生物学机制的理想人群，因为1）该手术非常普遍，2）术后抑郁发生率高，3）抑郁与较差的临床结局相关，4）进行性CAD是这些患者发病和死亡的主要原因。本研究的目的是评估CBT对所示生物标志物的影响，评估接受CBT的患者的抑郁症状和生物标志物之间的时间相关性，并描述抑郁症状变化与生物标志物变化和治疗的关系。采用两组随机实验设计。筛选后，114名重度抑郁症患者将随机接受常规护理和医疗护理或8周护士主导的CBT加常规护理。将在出院后1个月和3个月采集血样。将使用分层线性模型和逐步线性回归分析数据，控制人口统计学和临床变量的影响，包括年龄、性别、抗抑郁药使用、他汀类药物使用和心肺转流时间。