CC BY
7
"Educational bulletin "Consciousness" /"Образовательный вестник "сознание"
УДК 159.94:617-089.844
http://dx.doi.org/10.26787/nydha-2686-6846-2020-22-11-65-69
THE EFFICIENCY OF RENDERING PSYCHOLOGICAL ASSISTANCE TO PATIENTS WITH OBLITERATING DESEASES OF LOWER LIMB ARTERIES AFTER RECONSTRUCTIVE OPERATIONS
Popenko N.V., Chupina V.B., Gavrilenko L.S.
Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation
ЭФФЕКТИВНОСТЬ ОКАЗАНИЯ ПСИХОЛОГИЧЕСКОЙ ПОМОЩИ ПАЦИЕНТАМ С ОБЛИТЕРИРУЮЩИМИ ЗАБОЛЕВАНИЯМИ АРТЕРИЙ НИЖНИХ КОНЕЧНОСТЕЙ ПОСЛЕ РЕКОНСТРУКТИВНЫХ ОПЕРАЦИЙ
Попенко Н.В., Чупина В.Б., Гавриленко Л.С.
ФГБОУ ВО КрасГМУ им. проф. В.Ф. Войно-Ясенецкого, г. Красноярск, Российская Федерация
Abstract. Atherosclerosis, being a multifocal disease, has a pain syndrome as the main clinical manifestation. After reconstructive surgery, pain symptoms either decrease or are absent, it is logical to assume that the level of anxiety and depression will decrease to the limits of normal. However, a fairly high percentage of patients with clinical and subclinical manifestations of depression and anxiety were identified.
Consequently, pain is not a major factor in high rates of depression and anxiety. We assume that a serious illness that leads to disability and death puts a person in special living conditions. This situation affects the mental state of the patient. Even a technically competent operation does not always bring relief and recovery to the patient. The aim of the study was to study the effectiveness of psychological support for patients with chronic obliterating diseases of the lower limb arteries after surgery (reconstructive surgery). It should be noted that we did not pursue a long - term goal - the patient's awareness of the disease in the context of life, but set a short-term goal according to this time period-improving the emotional state through the patient's internal psychological resources. The study was aimed at implementing a program of psychological support for patients with chronic obliterating diseases of the lower limb arteries after surgery - reducing the level of depression and anxiety in patients in the postoperative period. The sample consisted of 15 patients on the 5th day after surgery.
After psychological support, the percentage of patients with clinical and subclinical manifestations of depression and anxiety decreased. This may indicate the effectiveness of the proposed assistance for violations in the emotional sphere.
Аннотация. Атеросклероз, являясь заболеванием мультифокальным, основным клиническим проявлением имеет болевой синдром. После проведенной реконструктивной операции, болевая симптоматика либо уменьшается, либо отсутствует, логично считать, что уровень тревоги и депрессии снизится до пределов нормы. Однако, был выявлен достаточно высокий процент больных с клиническими и субклиническими проявлениями депрессии и тревоги. Следовательно, болевой синдром не является главным фактором в высоких показателях депрессии и тревоги. Мы предполагаем, что тяжелое заболевание, которое приводит к инвалидизации и смертности ставит человека в особые жизненные условия. Данная ситуация отражается на психическом состоянии больного. Даже технически грамотно выполненная операция не всегда приносит пациенту облегчение и выздоровление.
Целью исследования явилось изучение эффективности психологического сопровождения пациентов с хроническими облитерирующими заболеваниями артерий нижних конечностей после оперативного вмешательства (реконструктивные операции). Необходимо отметить, что мы не преследовали долгосрочной цели - осознание пациентом болезни в контексте жизни, а ставили краткосрочную цель согласно данному периоду времени - улучшение эмоционального состояния посредством внутренних психологическихресурсов пациента. Проведенное исследование было направлено на реализацию программы психологического сопровождения пациентов с хроническими облитерирующими заболеваниями артерий нижних конечностей после оперативного вмешательства - снижения уровня
"Educational bulletin "Consciousness" /"Образовательный вестник "сознание"
Keywords: psychological assistance; depression, anxiety; obliterating atherosclerosis; patients with obliterating diseases of lower limb arteries; vascular profile hospital, internal resources.
депрессии и тревоги у пациентов в послеоперационном периоде. Выборка представлена 15 пациентами на 5-е сутки после операции.
После психологического сопровождения уменьшился процент пациентов с клиническими и субклиническими проявлениями депрессии и тревоги. Это может говорить об эффективности предложенной помощи при нарушениях в эмоциональной <
Ключевые слова: психологическая помощь; депрессия, тревога; облитерирующий атеросклероз; пациенты с облитерирующими заболеваниями артерий нижних конечностей; сосудистый профиль стационара, внутренние ресурсы.
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[3] Gavrilenko A.V., Skrylev S.I., Kuzubova E.A. (2002). Modern opportunities and the prospects of surgical treatment of patients with a critical ischaemia of the lower extremities. Angiology and Vascular Surgery. no. 4. P. 80-86.
[4] Karakoyun R., Koksoy C., §ener Z., Gunduz U., Kara-kaç B., Karakoyun M.Comparison of quality of life in patients with peripheral arterial disease caused by atherosclerosis obliterans or buerger's disease. Cardiovascular Journal of Africa 2014. vol. 25. no. 3. P. 124129. doi:10.5830/CVJA-2014-017.
[5] Kumbhani D.J., Steg G., Cannon C.P., Eagle K.A., Smith S.C., Goto S., Bhatt D.L. (). Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: Insights from the REACH registry. European Heart Journal. 2014. vol. 35. no. 41. P 2864-2872.
[6] Parissis J., Karavidas A., Farmakis D., Papoutsidakis N., Matzaraki, V., Arapi S., Filippatos G. Efficacy and safety of functional electrical stimulation of lower limb muscles in elderly patients with chronic heart failure: A pilot study. European Journal of Preventive Cardiology, 2015. vol. 22. no. 7. P 831-836. doi: 10.1177/2047487314540546.
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БИБЛИОГРАФИЧЕСКИМ СПИСОК
[1] Антипина И.Ю. Психологический возраст как отображение личностного ресурса // Известия Южного федерального ун-та. Технические науки. 2006. № 14. С. 82-87.
[2] Bjelland I., Dahl A.A., Haug T.T., Neckelmann, D. (). The validity of the hospital anxiety and depression scale: An updated literature review. Journal of Psychosomatic Research. 2002. vol. 52. no. 2. P. 69-77. doi: 10.1016/S0022-3999(01)00296-3.
[3] Гавриленко А.В., Скрылев С.И., Кузубова Е.А. Современные возможности и перспективы хирургического лечения больных с критической ишемией нижних конечностей // Ангиология и сосудистая хирургия. 2002. № 4. С.80-86.
[4] Karakoyun R., Koksoy C., Çener Z., Gunduz U., Karakaç B., Karakoyun M.Comparison of quality of life in patients with peripheral arterial disease caused by atherosclerosis obliterans or buerger's disease. Cardiovascular Journal of Africa 2014. vol. 25. no. 3. P. 124-129. doi:10.5830/CVJA-2014-017.
[5] Kumbhani D.J., Steg G., Cannon C.P., Eagle K.A., Smith S.C., Goto S., Bhatt D.L. (). Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: Insights from the REACH registry. European Heart Journal. 2014. vol. 35. no. 41. P 2864-2872.
[6] Parissis J., Karavidas A., Farmakis D., Papoutsidakis N., Matzaraki, V., Arapi S., Filippatos G. Efficacy and safety of functional electrical stimulation of lower limb muscles in elderly patients with chronic heart failure: A pilot study. European Journal of Preventive Cardiology, 2015. vol. 22. no. 7. P 831-836. doi: 10.1177/2047487314540546.
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[8] Prévost A., Lafitte M., Pucheu Y., Couffinhal T. Education and home-based training for intermittent claudication: Functional effects and quality of life. European Journal of Preventive Cardiology.
"Educational bulletin "Consciousness" /"Образовательный вестник "сознание"
[10] Volchkova N.S., Subkhankulov S.F. Prophylaxis of cardio-vascular diseases. The Bulletin of Contemporary Clinical Medicine. 2009. no. 4. P. 25-30.
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[9] Савельев В.С., Кошкин В.М. Критическая ишемия нижних конечностей. М.: Медицина, 1997. 160 с.
[10] Волчкова Н.С., Субханкулова С.Ф. Профилактика сердечно-сосудистых заболеваний // Вестник современной. клинической медицины. 2009. № 4. С. 25-30.
Author Contributions. Popenko N.V. - conceptualization; Chupina V.B. - writing a text; Gavrilenko L.S. - collection of materials.
Conflict of Interest Statement. The authors declare no conflict of interest.
Popenko N.V. - SPIN ID: 1535-0044; ORCID ID: 0000-0003-1399-8722 Chupina V.B. - SPIN ID: 2215-4081; ORCID ID: 0000-0002-9846-2216 Gavrilenko L.S. - SPIN ID: 1092-0742; ORCID ID: 0000-0001-7493-4947
Вклад авторов. Попенко Н.В. - концептуализация; Чупина В.Б. - написание текста; Гавриленко Л. С. - сбор материалов.
Заявление о конфликте интересов. Авторы заявляют об отсутствии конфликта интересов.
Попенко Н.В. - SPIN ID: 1535-0044; ORCID ID: 0000-0003-1399-8722 Чупина В.Б. - SPIN ID: 2215-4081; ORCID ID: 0000-0002-9846-2216 Гавриленко Л.С. - SPIN ID: 1092-0742; ORCID ID: 0000-0001-7493-4947
Introduction. Diseases of cardiovascular system take the 1st place among the lethality reasons. The damage of lower limb arteries takes the 2nd place in the structure of cardiovascular diseases. About 10% of patients have atherosclerosis of lower limb vessels (Gavrilenko et al., 2002).
Nowadays the obliterating diseases of vessels come out on the top on the frequency of implications and clinical value (Savelyev, Koshkin, 1997). The obliterating atherosclerosis of the arteries of the lower extremities (OAALE) occurs among 2-3% of population that makes 20% of all patients with cardiovascular diseases. Within 3-5 years gangrene develops at 10-40% of patients that leads to ablation of an extremity (WHO).
Results of numerous research studies demonstrate, that obliterating atherosclerosis of the arteries of the lower extremities tends to manifest among the younger generation. This disease is taped even more often at patients of working-age (Gavrilenko et al., 2002). In Russia the peak of this disease is the boundary of elderly and old age (60 - 70 years) (Savelyev, Koshkin, 1997; Woelk, 2012; Popenko, & Loginova, 2014).
State of the problem. A difficult life situation such as illness influences the mental activity of a patient and triggers changes under the influence of illness severity (Antipina, 2006). The operation executed brilliantly from the technical side cannot give to the patient relief and convalescence if the mentality has undergone changes (Kumbhani, Steg, Cannon, Eagle,
Smith, Goto, Bhatt, 2014; Sun, Zhang, Zou, & Chen, 2015; Parissis, Karavidas, Farmakis, Papoutsidakis, Matzaraki, Arapi, Filippatos, 2015). At the present stage an important task is to render psychological assistance to patients who underwent surgical interventions in the conditions of a hospital. The long-term goal such as awareness of illness in the context of whole life cannot be set, but it is possible to allocate achievement of the adequate purpose, according to this period of time - improvement of an emotional state by means of internal psychological resources of the patient.
Therefore, the objective of this research is to study benefits of the program of post-operative psychological assistance to patients with chronic obliterating diseases of the arteries of the lower extremities (Prévost, Lafitte, Pucheu, & Couffinhal, 2015; Karako-yun, Koksoy, §ener, Gunduz, Karakaç, & Karakoyun, 2014; Rudd, Subiakto, Asrarul Haq, Mutha, & van Gaal, 2014).
Materials and methods. The analysis of data received by means of psychological examination of patients with chronic obliterating diseases of the arteries of the lower extremities during the period from 2011 till 2012 in Krasnoyarsk became the basis for this study. A total of 15 patients were selected for participation in the program. Psychological assistance was rendered individually during the patients' medical treatment in a hospital. The patients who underwent a reconstructive operation (aorta-femoral shunting) were treated for 18days. During this time theyhad 7
Э-
"Educational bulletin "Consciousness" / "Образовательный вестник "сознание"
meetings with a psychologist. After the completion of the program the next stage of diagnostic procedures was underwent by the patients.
Hospital Anxiety and Depression Scale (HADS) (A. S. Zigmond and R. P. Snaith) which is aimed at identification of emotional disorders was used for the diagnostic. HADS was developed to provide doctors with the acceptable and easy in use practical tool for identification and quantitative assessment of depression and anxiety (Zigmond et al., 1983). The use of this questionnaire does not serve for the statement of the psychiatric diagnosis, but it serves for identification of depression and anxiety symptoms for the purpose of their further psychological correction (Bjelland, 2002).
Considering the person as a united system, such methods as the autogenic training method (Schulz, 1985), techniques of short-term positive psychotherapy (Yalov, 1997), one of methods of the standardized complex non-drug therapy program (Gi-rich, 2004) were used in the course of the implemented program.
This stage of investigation was directed to determination of changes in indices of depression and anxiety.
Statistical processing of the received data was executed by means of the SPSS program, version 19.0. For evaluation of significant changes in quality
of life the statistical analysis was performed before and after psychological rehabilitation.
The assessment of the variable distinction's significance in theconnected samplegroups for the quantitative signs was made with the use of the Student T-test. The Wilcoxon signed-rank test was used in case of the distributions differing from normal ones. In comparison of ordinal signs in the connected groups, for binary variables, and criterion of marginal homogeneity with number of categories more than twoMac-Nemara's criterion was used. Distinctions were evaluated as statistically significant in case of p<0.05.
Results and their discussion. Level of anxiety and depression. By results of the research the most noticeable changes happened (Figure 1) towards augmentation of number of patients with lack of authentically expressed symptoms (p<0.05). Before holding psychological assistance, patients demonstrated the following signs: the lowered mood, negative judgment concerning the events, pessimistic view on the future. Patients noted such disturbances as sadness, sleeplessness, loss of appetite. After psychological assistance according to the program patients showed improvement in the emotional sphere, many of them no-ticedthat their sleep was normalized.
Fig.1 - Depression indicators among patients before and after implementing the program of psychological assistance
During the data analysis (Figure 2) "before and after" the program of psychological assistance among patients (after reconstructive operations) minor changes on "Anxiety" scale with subclinical indicators towards augmentation of patient's number were observed.
More noticeable changes (p<0.05) were found towards decrease of "Anxiety" scale with clin-
ical implications and augmentation of patient's number with lack of authentically expressed anxiety symptoms.
Before participation in the program of psychological assistance patients demonstrated the following features: negative consequences of illness situations, feeling of uncertainty. Patients oftentrans-ferred negative thoughts from the experience of the past diseases and bound them to the future. Such clinical implications as heartbeat, sleeplessness, loss of
"Educational bulletin "Consciousness" / "Образовательный вестник "сознание"
appetite were also registered.After rendering the pro- In given cases decrease of "Anxiety" indica-
gram of psychological assistance the tendency to de- tor with implications of clinical symptoms is bound crease anxiety clinical symptoms was observed. Pa- to the fact that patients ceased to consider illness as tients adapted to new living conditions and ceased to "crash of life". project "anxious" thoughts on the future.
Anxiety
Absence of
Subclinical indicators Clinical indicators
verified indicators
Fig. 2 - Anxiety indicators among patients before and after implementation of the program of psychological assistance
The conducted research was referred on studying the decrease of depression and anxiety level after implementation of the program of psychological assistance in the postoperative period among the patients with an ischaemia of the III-IV degree according to A.V. Pokrovsky. A total of 15 patients (on the 5th day after surgery) were examined; and the repeated psychological diagnostics was carried out after rendering the organized psychological assistance. As atherosclerosis is a multifocal disease, the obliterating atherosclerosis of the arteries of the lower extremities is usually diagnosed much later. The main clinical implication is a pain syndrome. It is necessary to consider that this disease has the progressing character, and this research gives the ground to assume that the nature of this depression and anxiety is somatogenic. If after the performed reconstructive operation the painful symptoms either decrease, or are absent, it is logical to consider that the level of anxiety and depression will decrease to norm limits. However, rather high percentage of patients with clinical and sub-clinical implications of depression and anxiety was revealed.
Therefore, the pain syndrome is not the main cause of high rates of depression and anxiety. The data of this study allow assuming that the serious illness which may lead to disability and death puts a person in special life conditions. After psychological assistance the percentage of patients with clinical and subclinical manifestations of depression and anxiety decreased. This proves the benefits of the offered psychological assistance in case of impairments in the emotional sphere.
Conclusion. Thus, patients with the high level of depression and anxiety level on HADS scale in the postoperative period demonstrate positive dynamics after the implementation of the specially organized program of psychological assistance. The conducted research allows speaking about positive influence of psychological assistance to patients after reconstructive operations in departments of vascular surgery. In the prospects of internal psychological resources activation patients are less focused on the idea of possible disability and seek to adapt throughout the course of the disease.
Ответственный за переписку: Чупина Виктория Борисовна - доцент, доцент кафедры клинической психологии и психотерапии с курсом ПО, ФГБОУ ВО КрасГМУ им. проф. В.Ф.Войно-Ясенецкого Минздрава России, г. Красноярск, Российская Федерация, E-mail: ionessi@yandex.ru
Corresponding Author: Vikhareva Elena Vladimirovna - Associate Professor of the Department of Clinical Psychology and Psychotherapy, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Perm state pharmaceutical Academy, Krasnoyarsk, Russian Federation, E-mail: ionessi@yandex.ru —--—
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