Koroner arter baypas greft cerrahisi uygulanan hastalara bakım paketi uygulamasının deliryumu önlemedeki etkisinin belirlenmesi

Abstract

Deliryumu önlemede non-farmakolojik yöntemlere dair kanıtlar artarken, kulak tıkacı, müzik dinletisi ve kesintisiz aile varlığını içeren bir bakım paketinin etkinliği daha önce test edilmemiştir. Bu çalışma, koroner arter baypas greft cerrahisi geçiren hastalarda, bu üç müdahaleden oluşan bakım paketinin deliryumu önlemedeki etkisini değerlendirmek amacıyla gerçekleştirilmiştir. Araştırma izni Hasan Kalyoncu Üniversitesi Lisansüstü Eğitim Enstitüsü'nden (Onay No: 2023/11) ve etik onay Gaziantep Üniversitesi Klinik Araştırmalar Etik Kurulu'ndan (Onay No: 2023/187) alındı. Çalışma, Gaziantep Medical Point Hastanesi'nde 94 hasta üzerinde yürütülmüştür. Çalışma Grubu'na (n=47) bakım paketi uygulanırken, Kontrol Grubu'nda (n=47) standart klinik bakım sürdürülmüştür. Ölçümler ameliyat öncesi (T0) ve ameliyat sonrası üç zaman noktasında (T1, T2, T3) yapılmıştır. Deliryum değerlendirmesi DSM-V kriterlerine göre bir nöroloji uzmanı tarafından gerçekleştirildi, CAM-ICU ve diğer ölçümler yoğun bakım hemşiresi tarafından yapıldı. Kortizol, ACTH ve Glukoz düzeyleri için alınan kan örnekleri uluslararası standartlara uygun olarak analiz edildi. Veriler SPSS 22.0 programı ile t-testi, Mann Whitney U ve Ki-Kare gibi istatistiksel yöntemler kullanılarak analiz edilmiştir. p<0.05 değeri istatistiksel anlamlılık kriteri olarak kabul edildi. Bulgulara göre, DSM-V deliryum yanı kriterlerine göre deliryum tanısı alan hastaların insidansı ÇG'nda %27,66 KG'nda ise %57.45; CAM-ICU ile değerlendirilen deliryum insidansı Çalışma Grubu'nda %29.79, Kontrol Grubu'nda %53.19 olarak tesbit edildi. Kaygı seviyeleri ÇG'nda (3.2 ± 0.8) KG'nda (4.7 ± 1.1) anlamlı derecede düşük çıkmıştır (p=0.002). T2 ölçümlerinde kortizol düzeyleri ÇG'nda 15.4 µg/dL, KG'nda 21.6 µg/dL (p=0.012); ACTH seviyeleri ise sırasıyla 32.8 pg/mL ve 40.5 pg/mL olarak saptandı (p=0.034). RCUÖ uyku kalitesi puanı ÇG'nda anlamlı derecede yüksek bulunmuştur (62.7 ± 6.2) (p<0.001). Yapısal eşitlik modellemesi ile, bakım paketinin; uyku kalitesini artırdığı (β=0.52, p<0.001), Serum Kortizol (β=-0.45, p<0.001) ve Serum ACTH seviyelerini (β=-0.38, p<0.001) azalttığı ve kaygıyı düşürdüğü (β=-0.60, p<0.001) belirlendi. Uyku kalitesinin deliryumu önlemedeki dolaylı etkisi (β=-0.40, p<0.001) ve kaygının deliryum üzerindeki dolaylı etkisi (β=0.55, p<0.001) anlamlı bulundu. Bakım paketinin deliryumu doğrudan azaltma etkisi de istatistiksel olarak anlamlıdır (β=-0.50, p<0.001). Sonuç olarak, kesintisiz aile varlığı, müzik dinletisi ve kulak tıkacı kullanımını içeren deliryumu önleyici bakım paketinin uygulanmadı, deliryum insidansını azaltmada, kaygıyı düşürmede ve uyku kalitesini artırmada etkili bulundu.Non-pharmacological methods for preventing delirium are gaining evidence; however, the effectiveness of a care package, including earplugs, music therapy, and uninterrupted family presence, has not been previously tested. This study aimed to evaluate the effectiveness of a care package consisting of earplugs, music therapy, and uninterrupted family presence in preventing delirium in patients undergoing coronary artery bypass graft surgery. Research permission was obtained from the Hasan Kalyoncu University Graduate Education Institute (Approval No: 2023/11), and ethical approval was granted by the Gaziantep University Clinical Research Ethics Committee (Approval No: 2023/187). The study was conducted on 94 patients at the Gaziantep Medical Point Hospital. While the care package was implemented for the Intervention Group (n=47), the Control Group (n=47) received routine clinical care. Measurements were taken preoperatively (T0) and at three postoperative times (T1, T2 and T3). Delirium evaluations were conducted by a neurologist according to the DSM-V diagnostic criteria, while the CAM-ICU and other assessments were performed by intensive care nurses. Blood samples for cortisol, adrenocorticotropic hormone (ACTH), and glucose levels were analysed according to international standards. Data were analysed using SPSS 27.0, with statistical methods such as t-tests, Mann Whitney U, and Chi-square tests. Statistical significance was set at p<0.05. Study findings showed that the incidence of delirium assessed with DSM-V and CAM-ICU criteria was 17% in the Non-pharmacological methods for preventing delirium have gained increasing evidence; however, the effectiveness of care packages, including earplugs, music listening, and continuous family presence, has not been previously tested. This study aimed to evaluate the effectiveness of a care package consisting of these three interventions in preventing delirium in patients undergoing coronary artery bypass graft (CABG) surgery. Research approval was obtained from the Hasan Kalyoncu University Institute of Graduate Education (Approval No: 2023/11) and ethical approval from the Gaziantep University Clinical Research Ethics Committee (Approval No: 2023/187). The study was conducted at the Gaziantep Medical Point Hospital with 94 patients. The care package was applied to the Intervention Group (IG) (n=47), while standard clinical care was provided to the Control Group (CG) (n=47). Measurements were taken preoperatively (T0) and at three postoperative time points (T1, T2 and T3). Delirium was assessed according to the DSM-V criteria by a neurologist, while the CAM-ICU and other measurements were conducted by an intensive care nurse. Blood samples for cortisol, ACTH, and glucose levels were analysed in accordance with international standards. Data were analysed using SPSS 22.0 software with statistical tests such as t-test, Mann Whitney U, and Chi-Square. A p-value of <0.05 was considered statistically significant. According to the results, the incidence of delirium diagnosed using the DSM-V criteria was 27.66% in the IG and 57.45% in the CG. When evaluated using the CAM-ICU scale, delirium incidence was 29.79% in the IG and 53.19% in the CG. Anxiety levels were significantly lower in the IG (3.2 ± 0.8) than in the CG (4.7 ± 1.1) (p=0.002). Cortisol levels measured at T2 were 15.4 µg/dL in the IG and 21.6 µg/dL in the CG (p=0.012). ACTH levels were measured as 32.8 pg/mL in the IG and 40.5 pg/mL in the CG (p=0.034). Sleep quality scores measured using the RCSQ were significantly higher in the IG (62.7 ± 6.2) (p<0.001). Structural equation modelling showed that the care package increased sleep quality (β=0.52, p<0.001), reduced serum cortisol (β=-0.45, p<0.001) and ACTH levels (β=-0.38, p<0.001), and decreased anxiety (β=-0.60, p<0.001). The indirect effects of sleep quality on delirium prevention (β=-0.40, p<0.001) and anxiety on delirium (β=0.55, p<0.001) were also significant. The direct effect of the care package on reducing delirium was also statistically significant (β=-0.50, p<0.001). In conclusion, the implementation of a delirium-preventive care package, including continuous family presence, music listening, and earplugs, was found to be effective in reducing delirium incidence, lowering anxiety, and improving sleep quality.