Publikationsserver der Universitätsbibliothek Marburg
Titel:Präoperative Erwartungsoptimierung und deren psychoneuroimmunologische Effekte bei herzchirurgischen Patienten
Autor:Salzmann, Stefan
Weitere Beteiligte: Rief, Winfried (Prof. Dr.)
Veröffentlicht:2017
URI:https://archiv.ub.uni-marburg.de/diss/z2017/0708
URN: urn:nbn:de:hebis:04-z2017-07089
DOI: https://doi.org/10.17192/z2017.0708
DDC: Psychologie
Titel (trans.):Optimizing preoperative expectations and psychoneuroimmunological effects in heart surgery patients
Publikationsdatum:2018-06-26
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
Psychologische Intervention, Optimierung, Erwartungsoptimierung, Erwartung, Placebo, stress, preoperative psychological intervention, Psychologie, heart surgery, Stress, rct, cabg, Herzchirurgie, expectation optimization, Intervention

Zusammenfassung:
Die Koronare Herzkrankheit (KHK) ist eine der weltweit führenden Ursachen für Morbidität, krankheitsbedingte Beeinträchtigung, Erwerbsunfähigkeit und Mortalität (Go et al., 2014; Halaris, 2013; Murray & Lopez, 2013; Naghavi et al., 2015). Die aortokoronare Bypass-Operation hat sich als Goldstandard für die Behandlung für Patienten mit schwerer KHK durchgesetzt (Cohen et al., 2011). Ein substanzieller Teil der Patienten profitiert nach der Operation jedoch nicht in dem Ausmaß, wie es die Chirurgen von einem medizinischen Standpunkt aus erwarten würden (Hawkes, Nowak, Bidstrup & Speare, 2006). Krankheitsbedingte Beeinträchtigung und gesundheitsbezogene Lebensqualität können unbefriedigend bleiben, obwohl die Herzfunktion wieder ausreichend hergestellt ist (Hawkes et al., 2006). Erwartungen spielen bei einer aortokoronaren Bypass-Operation eine wichtige Rolle für das Behandlungsergebnis (Auer et al., 2016; Juergens, Seekatz, Moosdorf, Petrie & Rief, 2010). Eine Optimierung präoperativer Erwartung hat also das Potenzial postoperative Ergebnisse positiv zu beeinflussen. Deshalb wurde die PSY-HEART-Studie (PSYchologische Intervention bei HERZchirurgischen Patienten) durchgeführt. Sie sollte untersuchen, ob mit Hilfe einer Erwartungsoptimierung die langfristigen Operationsergebnisse herzchirugischer Patienten verbessert werden können. Dazu wurden in einer prospektiven dreiarmigen randomisierten klinischen Studie mit einem 6-Monats-Follow-Up 124 Patienten, die vor einer elektiven aortokoronaren Bypass-Operation standen, randomisiert. Die Patienten erhielten entweder die präoperative psychologische Kurzintervention zur Erwartungsoptimierung (EXPECT), eine supportive präoperative psychologische Kurzintervention, die sich auf emotionale Unterstützung, jedoch nicht auf Erwartungen fokussierte (SUPPORT) oder ausschließlich medizinische Standardbehandlung (SMC; ohne präoperative psychologische Gespräche). Innerhalb dieses größeren Projekts sind die Studien 1-3 entstanden sind. Im Rahmen der ersten Fragestellung dieser kumulativen Dissertation sollte eine präoperative psychologische Kurzintervention zur Erwartungsoptimierung für Pati-enten vor einer aortokoronaren Bypass-Operation entwickelt und beschrieben wer-den. In Studie 1 konnte gezeigt werden, dass die Intervention von den Patienten gut angenommen wurde und nebem dem „Alltagsgeschäft“ einer herzchirurgischen Sta-tion durchführbar war. Da Stress mit der Entstehung von Erkrankungen assoziiert ist (Chrousos, 2009; Nater, Skoluda & Strahler, 2013), durch Erwartungen beeinflusst wird (Goldstein, 2010; Lazarus & Folkman, 1987; Ursin & Eriksen, 2010) und den Zusammenhang zwischen Erwartungen und Behandlungsergebnissen erklären könnte, sollten in Studie 2 & 3 die Effekte der erwartungsoptimierenden Intervention auf physiologische Stress- (Studie 2) und pro-inflammatorische Parameter (Studie 3) untersucht werden. Studie 2 konnte zeigen, dass beide psychologischen präoperativen Interventionen postoperativ zu einem signifkant niedrigeren Adrenalin-Level führten, während niedrigere Adrenalin-Level mit einer geringeren krankheitsbedingten Beeinträchti-gung 6 Monate nach der Operation assoziiert waren. In Studie 3 konnte gezeigt wer-den, dass beide präoperativen Interventionen zu niedrigeren postoperativen Inter-leukin-8-Konzentrationen im Vergleich zur SMC-Gruppe führten, während sich ein spezifischer Effekt für die Erwartungsintervention im Sinne geringerer Interleukin-6-Level im Vergleich zur SMC-Gruppe sechs Monate nach der Operation zeigte. Um die Ergebnisse aus den Studien 1-3 zu vertiefen, wurde in Studie 4 eine neue psychologische Kurzintervention zur spezifischen Steigerung persönlicher Kontroll-erwartungen vor einem Stressor mit einer Dankbarkeits- sowie einer Ablenkungs-Interventionen in einer gesunden Stichprobe verglichen. Dabei sollten die Effekte auf die wahrgenommme sowie biologische Stressreaktion nach einem akuten Stressor in einem experimentellen Design untersucht werden. Die Erwartungs- und die Ablen-kungsintervention zeigten einen stressreduzierenden Effekt auf Cortisol nach einem akuten Stressor im Vergleich zur Dankbarkeitsgruppe, wobei Optimismus und dispositionelle Dankbarkeit die Interventionseffekte moderierten. In der vorliegenden Dissertation ist es gelungen im Rahmen der PSY-HEART-Studie zu zeigen, dass eine neu entwickelte präoperative psychologische Kurzintervention zur Erwartungsoptimierung bei Patienten, die vor einer aortokoronaren Bypass-Operation stehen, die postoperative physiologische Stressantwort positiv beeinflus-sen kann und sich dies im Sinne einer geringeren krankheitsbedingten Beeinträchti-gung positiv auf Langzeitergebnisse (sechs Monate nach der Operation) auswirkt. Auch in einem experimentellen Design konnte eine kurze ewartungsoptimierende Intervention vor einem Stressor die physiologische Stressreaktion nach einem Stres-sor reduzieren.

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