颈动脉支架成形术对颈内动脉重度狭窄患者认知功能的影响

目的观察颈动脉支架成形术(CAS)对颈内动脉重度狭窄患者认知功能与生活质量的影响。方法选择32例未发生大面积脑梗死的重度颈动脉狭窄(狭窄程度≥70%)患者行CAS,手术前及术后3个月采用简易智能状态检查量表(MMSE)及视觉保持测验(VRT)观察认知功能的变化,用WHO生存质量量表简表(WHOQOL-BREF)观察患者生活质量变化。结果所有患者均成功行CAS,成功率100%。与术前颈动脉狭窄率比较,术后3个月狭窄率明显降低[(83.4±7.6)%vs(4.3±1.3)%,P<0.01];与术前比较,术后3个月MMSE评分、VRT正确计分、WHOQOL-BREF评分明显升高,差异有统计学意义(P<0.05);VRT错误计分明显降低,差异有统计学意义(P<0.05)。随访期无症状性脑卒中复发。结论严重颈动脉狭窄可能是导致患者认知功能障碍的原因之一,CAS可以改善患者的认知功能和生活质量。     

非体外循环和体外循环冠状动脉旁路移植术生活质量比较

目的:用一个普适生活质量量表和一个疾病特异量表随机对照研究非体外循环和体外循环冠状动脉旁路移植术患者生活质量改变的情况。方法:应用健康标准化量表简短表格36(SF-36),西雅图心绞痛调查问卷(SAQ)分析研究2006-01-2010-10这5年间147例冠状动脉旁路移植术患者资料,其中非体外循环冠状动脉旁路移植术组96例、体外循环组51例。调查时间是术前1周,术后6～12个月。结果:术前两组患者问卷结果相似。术后6～12个月,SF-36问卷显示在生理职能、社会功能、精神健康等方面,非体外循环组优于体外循环组;SAQ问卷在心绞痛程度、心绞痛频率、生活质量方面,非体外循环组优于体外循环组。结论:术后6～12个月非体外循环较体外循环冠状动脉旁路移植术对患者生活质量改善更明显。     

环肺静脉前庭电隔离术对慢性心力衰竭合并心房颤动患者生活质量的影响

目的:探讨以环肺静脉电隔离为主要术式的导管消融治疗对慢性心力衰竭(心衰)合并心房颤动(房颤)患者心功能及生活质量的影响。方法:入选接受导管消融治疗的慢性心衰合并持续性房颤患者33例为研究对象。在Carto系统指引下进行环肺静脉前庭消融术,消融线距离肺静脉口部20~30mm。以心房-肺静脉间电传导完全被阻滞作为消融终点,术前、术后1周及术后6个月行二维心脏超声检查,测定左房内径(LAD)、左室舒张末期内径(LVD)及射血分数(EF),评价心功能变化。同时应用生活质量评价量表SF-36评价患者术后生活质量情况。结果:所有患者均顺利完成双侧肺静脉完全电隔离,无一例出现严重并发症。平均随访(12.8±5.4)个月,复发6例(3个月空白期后),有2例进行了二次消融,未再复发。与术前比较,术后1周LAD、左室EF及各项生活质量评分均无明显变化(P0.05),与术后6个月相比有显著的统计学差异(均P0.05)。结论:环肺静脉前庭电隔离术治疗慢性心衰合并房颤患者是安全、有效的,可恢复窦性心律、逆转心房重构、增加左室舒张末期容积,改善患者心功能,提高患者生活质量。     

老年非创伤性股骨头缺血性坏死患者人工全髋关节置换术后中远期随访结果

目的评价随访全髋关节置换术后的老年非创伤性股骨头缺血性坏死(ANFH)患者临床治疗效果及病患生活质量。方法采用髋关节功能Harris评分及生活质量SF-36评分对老年非创伤性ANFH患者全髋关节置换术前评价及术后长期随访,采用自身对照,评价手术前后患者躯体功能及生活质量。结果髋关节功能Harris评分显示,术后总体评分及优良率均显著高于术前(P<0.05);术后不同病因之间评分差异无统计学意义(P>0.05),但男性患者评分显著高于女性(P<0.05)。SF-36量表评分,在总体水平上,总体健康(GH)、生理健康及心理健康三个维度中术后评分均显著高于术前(P<0.05);在心理健康维度,术后男性得分显著高于女性(P<0.05)。结论人工全髋关节置换对老年非创伤性ANFH患者疗效较好,且对不同病因的疗效没有差异;心理状况可能是影响术后不同性别患者之间功能恢复的一个因素,应注重术后患者的心理疏通及引导。     

双心室起搏对慢性心力衰竭患者心肺功能和生活质量的影响

目的观察双心室起搏对慢性心力衰竭患者心肺功能和生活质量的影响.方法慢性心力衰竭伴室内传导阻滞患者9例,比较双心室起搏前后患者超声心动图、心肺功能以及生活质量的变化.结果双心室同步起搏后,患者左心室射血分数(%)由术前21.6±6.7增加到27.3±5.2(术后3个月,P<0.05)、29.5±5.4(术后6个月,P<0.05),6分钟步行距离(m),由术前320±97增加到384±103(术后3个月,P<0.01)、413±110(术后6个月,P<0.01),峰值氧耗量、摄氧效率斜率及每分通气量/每分二氧化碳产生量斜率较术前均有显著增加.生活质量评分分别改善30%(术后3个月,P<0.01)、28%(术后6个月,P<0.01).结论双心室起搏能有效改善慢性心衰患者心肺功能,增加运动能量,提高生活质量.     

从老年患者探讨阵发性室上性心动过速射频消融时机

目的对阵发性室上性心动过速(PSVT)射频消融(RFCA)治疗的时机进行探讨。方法回顾分析接受RFCA治疗,且年龄≥60岁的老年患者的临床资料。结果 36例PSVT患者,年龄68.72±5.78岁。除1例外,其余35例首次出现症状至入院行RFCA治疗的间隔131.23±131.98(1~564)个月。18例首次发病年龄<60岁,占总数的50%。36例中,10例因PSVT引发严重心血管事件而接受RFCA治疗,26例因PSVT明显影响生活质量而接受RFCA治疗。术后平均随访24.53±14.16个月,仅1例复发,RFCA治疗成功率为97.22%。术后随访期间,没有患者发生因PSVT而引发的心血管事件。结论 PSVT患者,特别是老年患者,应及早接受RFCA治疗。     

宫腔镜下手术分离人工流产术后宫腔粘连的效果及术后生活质量评价

目的 观察宫腔镜下手术分离人工流产术后宫腔粘连的效果,并评价手术前后患者的生活质量.方法 选择人工流产术后宫腔粘连患者43例,均行宫腔镜下手术分离,观察术后临床效果;采用SF-36量表评价手术前后患者生活质量.结果 43例患者经宫腔镜下实施分离手术,置宫内节育环,术后90d人工周期综合治疗,月经均恢复正常.在完成生活质量评价的所有患者中,除SF-36量表中生理职能、一般健康状况及社会功能三项指标外,术后及术后6个月的患者生活质量（生理机能、躯体疼痛、活力、情感职能以及精神健康）评价均显著优于术前（P均＜0.05）.结论 宫腔镜下手术分离人工流产术后宫腔粘连的效果较好,术后患者生活质量有不同程度改善.     

经导管环肺静脉左房线性消融术对阵发性心房颤动患者左心房结构和功能的影响

目的: 评价环肺静脉左房线性消融术对阵发性心房颤动（房颤）患者左心房结构和功能的影响。方法: 阵发性房颤患者33例,Carto系统下行环肺静脉左房线性消融术,应用超声心动图测定其消融术前1～3 d、术后1、3、6、12个月静息时窦性心律下左心房内径、容积指标、二尖瓣口A波速度峰值(VA)及E波速度峰值(VE),并计算左心房排空分数,分析消融术前后左心房结构和功能的变化。结果: 33例阵发性房颤患者均成功施行环肺静脉左房线性消融术,1年治愈率82%。左房前后径消融术后1个月较术前显著增大［(44±4)mm vs. （41±3）mm,P<0.01］,术后3个月、6个月时与术前比较无显著差异,随访1年时左房前后径较术前有显著减小［（40±3）mm vs. (41±3)mm,P<0.05］。与左心房辅助泵功能相关的左心房最小容积,术后1个月显著增大,左心房主动排空分数、左心房总排空分数显著降低（P<0.05),术后3个月时恢复到术前水平。VA术后均低于术前（P<0.05,P<0.01）,而VE/VA术后1个月显著上升（P<0.05,P<0.01）,但在随后的随访中与术前无显著差异。 结论: 阵发性房颤患者左房环肺静脉线性消融术后近期左房前后径增大,辅助泵功能下降,术后3个月恢复至术前水平,术后1年左房结构可部分逆重构。     

VVI型起搏器治疗Ⅲ度房室传导阻滞疗效观察

目的 探讨VVI型起搏器治疗Ⅲ度房室传导阻滞(AVB)的临床疗效.方法 采用VVI型起搏器,对36例心功能NYHA分级Ⅱ～Ⅳ级的Ⅲ度AVB患者行右室心尖部或右室间隔起搏治疗,术前及术后12个月用心脏彩超检测其左室射血分数(LVEF)、左室短轴缩短率(FS)、每搏输出量(SV)、心输出(CO)、心脏指数(CI),并行6 min步行试验(6-MWD).结果 患者均顺利完成置入手术,随访12～24个月,术后症状明显改善,生活质量提高,无严重置入起搏器相关并发症发生.与术前比较,患者心功能改善,CO、CI增加(P均＜0.05);EF、FS、SV下降,6-MWD改善,但无统计学差异(P均﹥0.05).结论 Ⅲ度AVB患者行VVI型起搏器治疗后CO、CI增加,活动耐量及生活质量提高.     

49例双极射频消融改良迷宫手术治疗心脏病合并心房纤颤

目的 探讨心脏手术同期进行双极射频改良迷宫手术（Cox maze Ⅲ）治疗心房颤动（AF）的手术效果,研究术后窦性心律维持率及其与左心房大小的关系.方法 2008年4月至2010年6月心脏病合并AF的患者接受心脏手术,同期行房颤改良双极射频消融手术,比较手术前后心电图前后心电图、超声心动图各项指标及心功能变化.结果 全组无手术死亡,术后低心排除量综合征1例,频发室性早搏并短阵室性心动过速2例.全部患者顺利出院.术后失访1例,1例于术后6个月死于栓塞.47例随访存活者,随访3～29个月,3个月、6个月和1年以上稳定窦性心律分别为36/48（75.0%）、36/40（90.0%）和20/22（90.9%）,心功能（NYHA）Ⅰ级41例、Ⅱ级6例,超声显示左房明显缩小.结论 心脏手术中行Cox maze Ⅲ治疗AF安全有效,临床效果良好.随着术后时间延长,稳定窦性心律逐步增加,左房≤60 mm者窦性心律维持率高于≥60 mm者.     

慢性心房颤动患者射频消融术后生活质量及临床症状变化

目的 通过观察患者生活质量和临床症状的变化来探讨射频消融术治疗慢性心房颤动(atrialfibrillation,AF)的疗效.方法 41例慢性AF患者接受经导管射频消融术,于术前3 d内和术后3个月用SF-36量表及症状列表评估患者生活质量和症状严重程度.结果 41例慢性AF患者接受射频消融术治疗,随访时间178 d～515 d,36例顺利完成随访并按消融术效果分为成功组(23例)和复发组(13例).射频消融术后3个月的生活质量评分与术前比较,躯体功能、躯体角色、社会功能、情感角色和精力有明显提高(P<0.05),而肌体疼痛、心理健康和总的健康状况方面差异无统计学意义(P>0.05).术后3个月的临床症状评分与术前比较,心悸与心动过速症状减轻,而呼吸困难、胸痛、头昏和活动受限变化差异无统计学意义.从治疗结果 分析,成功组和总体改变一致,而复发组虽然心悸和心动过速症状减轻,但在生活质量的8个维度评分变化差异无统计学意义(P>0.05).结论 慢性AF患者接受导管射频消融术后可以减轻症状,改善生活质量.     

导管消融术对心房颤动患者生活质量的影响

目的探讨导管消融术对心房颤动（房颤）患者生活质量的影响。方法70例房颤患者接受导管消融,男40例,女30例,年龄（51．2±16．1）岁,于消融术前和术后1、3、6个月用SF-36健康随访表评估患者生活质量,66例顺利完成随访,按消融效果分为成功组（54例）和复发组（12例）。结果射频消融术后1、3、6个月的房颤患者生活质量评分与消融前比较,躯体功能、躯体角色、社会功能、情感状态和精力有明显提高（P〈0,05）,其中除了社会功能外,其余4个指标消融术后各个时间点比较,差异无统计学意义（P〉0．05）,而社会功能消融术后各时间点进行比较,差异有统计学意义（P〈0．05）,而驱体疼痛、心理健康和总的健康感觉方面差异无统计学意义（P〉0．05）。成功组的房颤患者射频消融术后1、3、6个月的生活质量评分与消融前比较,躯体功能、躯体角色、社会功能、情感状态和精力有明显改善（P〈0．05）。复发组生活质量8个评价指标分值变化的差异无统计学意义（P〉0．05）。结论导管消融术可以早期改善房颤患者的生活质量。     

射频消融对室性早搏患者生活质量的影响

目的观察室性早搏(简称室早)患者射频消融术前后生活质量的变化,探讨射频消融对室早患者生活质量的影响。方法入选58例,男27例、女31例,年龄30±34(17~67)岁,其中51例右室流出道室早,5例左室流出道室早,2例左室流入道室早,在术前和术后分别填写SF-36调查表,由患者本人在半小时内完成,观察一般健康状况(GH)、生理功能、生理职能(RP)、躯体疼痛、精力、社会功能、情感职能(RE)、精神健康指标,量表采用标准分法进行评分、统计分析。结果所有患者均成功地进行了射频消融,术后1周至1个月内,患者整体的生活质量有明显提高;不同年龄段生活质量改变无显著差异;但对女性的改变程度的GH、RP、RE3个指标较男性更显著,P<0.05。结论射频消融治疗室早能显著改善患者生活质量。     

Quality of life after lung cancer surgery: video-assisted thoracic surgery versus thoracotomy

OBJECTIVE: To assess the benefit of video-assisted thoracic surgery (VATS), we compared time-related quality of life (QOL) after lobectomy performed by VATS to that performed by thoracotomy. METHODS: Thirty-three patients underwent surgery for lung cancer during the period April 2001 through November 2002 completed a mailed questionnaire after surgery. RESULTS: Over time, improved QOL was reported in six dimensions by VATS patients but in only two dimensions by thoracotomy patients. There was significant improvement in bodily pain subscores in both groups during the 36 months after surgery. At 3 months after surgery, QOL scores for all eight dimensions were lower in the VATS group, but QOL scores for all eight dimensions did not differ significant between groups at 3 or 12 months after surgery. At 36 months after surgery, QOL scores for six dimensions were higher in the VATS group, and the difference was significant in scores for two dimensions. CONCLUSION: We found recovery was quicker in patients who underwent VATS than in those who underwent thoracotomy.     

The impact of dialysis modality on quality of life: a systematic review

Background: This systematic review aims to generate evidence on which dialysis modality (in‐centre haemodialysis HD, or peritoneal dialysis, PD) improves the quality of life (QOL) of end stage renal disease (ESRD) patients. Methods: MEDLINE, CINAHL and EMBASE were searched from their inception to July 2010 for studies that compared QOL in both HD and PD patients. Results: Only 26 of the 574 studies identified were included in this review. These were crosssectional, longitudinal or retrospective in design. QOL tools used include SF‐36, Kidney Disease Quality of Life (KDQOL) and CHOICE Health Experience Questionnaire (CHEQ). PD patients mostly rate their QOL higher than HD patients. Yet HD patients may enjoy a relatively better QOL in the physical dimensions over time. Mental health components are comparable between both dialysis populations. Conclusion: There is no simple ‘yes’ or ‘no’ answer to the question of which dialysis modality improves QOL. However a good understanding of the evidence base will facilitate individual decision‐making.     

Effect of pulmonary rehabilitation on quality of life in patients with COPD: the use of SF-36 summary scores as outcomes measures

PURPOSE: Pulmonary rehabilitation (PR) is an accepted therapy for patients with chronic obstructive pulmonary disease (COPD), improving both exercise capacity and quality of life (QOL). Generic measures of QOL have been criticized as being insensitive to detecting the improvement in QOL after PR in contrast to disease-specific instruments. The authors looked at the Medical Outcomes Survey Short Form 36-item questionnaire (SF-36), a generic QOL measure, to detect changes in QOL in COPD patients after completion of PR. METHODS: Patients with COPD who participated in a PR program completed the QOL questionnaire before and after completion of PR. Exercise tolerance was assessed by the 6-minute walking test. Quality of life was assessed by the SF-36; the authors calculated its eight dimensions as well as mental (MCS) and physical (PCS) component summary scores. RESULTS: The patients realized a significant improvement in exercise tolerance; 6-minute walking test distance increased from 470 +/- 104 m (mean +/- standard deviation) to 536 +/- 133 m (P = 0.0006) after PR. Quality of life also improved in nearly all dimensions and in both summary scores; PCS improved from 26.1 +/- 8.0 before PR to 30.5 +/- 9.0 after PR (P = 0.008) and MCS improved from 27.9 +/- 7.0 before PR to 34.1 +/- 5.0 after PR (P = 0.0002). CONCLUSION: The SF-36 and its summary scores are sensitive instruments to detect improvement in QOL in COPD patients after PR.     

The Patient Reported Outcomes in Lupus (PATROL) study: role of depression in health-related quality of life in a Southern California lupus cohort

This study examines the relationship between psychosocial factors, ethnicity, disease activity and quality of life in systemic lupus erythematosus. Methods: One hundred and twenty-five adult Caucasian and Hispanic lupus patients were recruited from four Southern California medical centers. Linear regression analysis was performed to assess the correlation of ethnicity, socioeconomic factors (age, income), and disease activity (patient and physician reported), as well as psychological (depression, internality, helplessness) variables with quality of life (QOL) as measured by the Short Form (SF)-36. Hierarchical multiple regression analysis was then used to determine the stepwise contribution of the above determinants on the eight domains of the SF-36 questionnaire. Results: Depression negatively correlated with QOL in both Caucasians (r -0.488 to -0.660) and Hispanics (r -0.456 to -0.723). Patient-reported disease activity was moderately related (r -0.456 to -0.698) to seven of the eight SF-36 domains in Hispanics, and none in Caucasians. Physician-reported disease activity, measured by SLEDAI, did not correlate with QOL among Hispanics or Caucasians. When linear and hierarchical regression was used, depression significantly correlated (p < 0.0001) with the majority of the SF-36 domains, except general health, while age had a significant effect in only one domain of the SF-36, physical functioning (p < 0.0001). Conclusion: Depression, and not disease activity, appears to have a major influence on quality of life in both Hispanic and Caucasian patients in this lupus cohort.     

上胃肠道功能和动力障碍性疾病患者的生活质量评价

背景：功能性胃肠病（FGIDs）和胃肠动力障碍性疾病（DGIMs）严重影响患者的生活质量。研究患者的健康相关生活质量（HRQL）对深入理解FGIDs和DGIMs的特点以及评价疗效具有重要意义。目的：评估不同上胃肠道FGIDs和DGIMs患者的生活质量。揭示我国FGIDs和DGIMs患者的生活质量状况和意义。方法：以汉化版简明健康调查量表（SF-36）对140名健康对照者以及135例功能性消化不良（FD）患者、50例非糜烂性反流病（NERD）患者和100例反流性食管炎（RE）患者进行生活质量调查,得到生活质量8个维度的评分和2个综合评分[躯体生理健康总评（PCS）和精神心理健康总评（MCS）]并进行分析比较。瘩果：FD、NERD和RE组的所有8个维度和2个综合评分均显著低于健康对照组（P〈0.05）。其中,FD组生活质量最低。MCS评分下降最为突出。除躯体疼痛外。FD组其他7个维度和2个综合评分均显著低于RE组（P〈0.05）。与NERD组相比,FD组的社会功能、情感职能、精神健康维度和MCS评分显著降低（P〈0．05）。NERD组的生活质量较RE组下降更明显,总体健康、活力维度和PCS评分显著低于RE组（P〈0．05）。结论：FGIDs和DGIMs患者的生活质量明显下降,躯体生理健康和精神心理健康均明显受损。FGIDs患者的生活质量较DGIMs患者更低。尤其是在精神心理健康方面。诊治FGIDs和DGIMs时应重视患者生活质量的评价和改善。     

不同起搏方式对病态窦房结综合征患者生活质量的长期影响

目的:本研究旨在评价两种起搏方式[单心房按需(AAI)起搏和双腔按需(DDD)起搏]对患者起搏器植入术后生活质量的长期影响.方法:采用多中心随机对照方法,将患者分入AAI组(57例)和DDD组(86例).在起搏器植入前、植入后6个月,之后每年1次的随访中,根据随访期间的健康状况填写36条简明健康问卷(SF-36量表).38例完成3年随访,且SF-36量表资料完整的患者被纳入生活质量研究.结果:与起搏器植入前相比,起搏器植入术后6个月,患者除躯体疼痛稍下降外,生活质量其余各维度均较起搏器植入术前提高,但差异未达到统计学意义;术后1年患者总体健康评分增高,同时AAI组总体健康评分也高于DDD组(P均＜0.05);起搏器植入术后2年,起搏器患者生理功能、总体健康、活力及社会功能的评分均较起搏器术前显著增高(P均＜0.05);两两比较显示,除了AAI组总体健康评分显著优于DDD组外(P＜0.05),两组患者其他各维度的评分差异仍无统计学意义.结论:心脏起搏治疗能明显提高患者的生活质量,而AAI起搏方式对生活质量的改善明显优于DDD起搏方式.     

Comparison of the quality of life between HIV-positive haemophilia patients and HIV-negative haemophilia patients

Summary. In a prospective study, we tested the hypothesis that an already reduced quality of life in haemophilia patients is further diminished in those haemophilia patients who contracted the human immunodeficiency virus (HIV) as a result of transfusion of coagulation factor preparations. From an available pool of 92 males with haemophilia A or B, 18 patients seropositive for HIV infection and 11 seronegative patients were randomly selected for the study. We applied two instruments to measure the quality of life (QOL) in our patients. The first instrument was the quality of well-being (QWB) scale that unifies QOL into a single score based upon an assessment of the patient's symptoms and health-related reductions in mobility, physical activity and social activity. The second instrument was SF-36, the questionnaire from the Medical Outcome Study (MOS) that measures six dimensions of health status (physical functioning, role functioning, social functioning, pain, mental health and health perception). Measurements were obtained with both instruments at three interviews with each patient over a 1-year interval. As expected, HIV disease reduces QOL in haemophiliacs. The number of bleeding episodes within 2 months of interview was increased in the HIV-positive cohort but not within 6 days of interview, indicating that HIV disease independently affects QOL in haemophilia patients. In a typical 30-year-old patient, haemophilia itself has reduced quality of their lives by 9.3 years, and HIV disease additionally from 8.5 to 20 years. On the MOS scales, the two patient groups differed significantly only in the dimensions of health perception and pain magnitude. Although HIV disease led to a decrement in QOL of haemophilia patients, it also appears that haemophilia patients are able to develop coping skills to prevent more drastic effects of HIV disease on their QOL. Future studies will need to explore the nature and mechanisms of this ‘buffering’ effect.