Health-related quality of life in adults after repair of congenital diaphragmatic defects--a questionnaire study

Background and Aim

Long-term respiratory, gastrointestinal, and vertebral sequelae are common after repair of congenital diaphragmatic defects (CDDs). The aim of this study was to assess the effect of these sequelae on the health-related quality of life (HRQoL) of adult survivors after CDD repair.

Materials and Methods

A questionnaire, including 36-Item Health Survey Form (SF-36), 36-item Gastrointestinal Quality of Life Index (GIQLI), 55-item Psychosocial Survey, 9-item survey for Respiratory Symptoms-Related Quality of Life Index, and a symptoms query, was sent to 94 adult survivors of CDD and to 400 healthy control subjects. One SD lower than the age-adjusted national average in the 36-Item Health Survey Form score for physical or mental health was considered as low HRQoL.

Results

Sixty-nine patients with CDD (72%) and 162 (41%) control subjects returned the questionnaire. The initial presentation was critical in less than 10% of patients with CDD. Forty-five patients with diaphragmatic hernia had primary closure; in 1 patient with diaphragmatic hernia, a patch was used. Twenty-four patients had plication of diaphragmatic eventration. The incidence of gastroesophageal reflux (20% vs 2%), recurrent intestinal obstruction (7% vs 0%), and recurrent abdominal pain (12% vs 2%) was significantly higher in patients with CDD than in control subjects, whereas no difference in the incidence of respiratory, musculoskeletal, or other health problems not associated with CDD was found. Scores in GIQLI, Psychosocial Survey, and Respiratory Symptoms-Related Quality of Life Index did not differ between patients with CDD and control subjects. Health-related quality of life was low in 17 (25%) of 69 patients with CDD, which exceeded 1.5 times the expected value. There was no correlation between the type or severity of the primary defect and HRQoL at the time of the study.

Conclusion

Most adults with repaired CDD have good or satisfactory HRQoL. Congenital diaphragmatic defect-associated symptoms with or without acquired diseases significantly impair HRQoL in one fourth of the patients.     

冠状动脉旁路移植术后病人生存质量探讨

目的观察研究冠状动脉旁路移植（CABG）术病人术前、术后生存质量（QoL）。方法分为体外循环手术组（ONCAB）和非体外循环手术（OPCAB）组，于手术前1周内、术后3个月和6个月进行西雅图心绞痛调查表（SAQ）和SF-36量表的测评。结果SAQ各项内容评分，术前以心绞痛稳定状态（AS）得分最低，术后各项目有明显好转；SF-36的生理健康内容（PCS）和心理健康内容（MCS）在术后均有不同程度改善；ONCAB和OPCAB两组之间各纬度得分在术后3．6个月比较差异均无统计学意义。结论冠状动脉旁路移植术后病人生活质量提高。ONCAB和OPCAB组生存质量比较差异无统计学意义。     

Quality of Life in the Surgical Treatment of Gynecomastia

Background  Gynecomastia has an incidence of up to 60% of adolescents, causing pain and self-image disorders for the patient, leading to emotional and physical problems that can be reversed with treatment. This prospective case control study assessed the surgical treatment of gynecomastia and its impact on quality of life. Methods  Thirty-three patients aged 18–50 years and with 2–21 years of gynecomastia progression were included in the study. Adenectomy was performed. Preoperatively and 6 months postoperatively, patients completed the Brazilian version of the Short-Form 36 (SF-36) quality of life questionnaire. Results  There was improvement in the SF-36 domains of General Health, Functional Capacity, Social Aspects, Vitality, and Mental Health. Conclusion  The Short-Form 36 questionnaire demonstrated that surgical treatment of gynecomastia afforded positive changes in quality of life.     

Health-related quality of life after hip replacement

Abstract Total hip replacement is widely known to be effective in the management of pain and functional status. Instead, less is known regarding patients perspective through the measurement of health-related quality of life. A retrospective study was conducted to evaluate patient-relevant outcomes in a homogeneous sample of patients who underwent total hip replacement. Long-term results were evaluated through a self-administered questionnaire and clinical examination. We were able to re-contact 84.8% of patients at the follow-up, at an average of 7.35 years. The results confirm the value of the treatment of hip arthritis, demonstrating the impact of hip replacement on physical function and pain and consequently on the improvement of quality of life.     

宁夏地区不同人群腹膜透析患者生活质量及其影响因素

目的探讨宁夏地区不同人群腹膜透析患者生活质量及其影响因素,旨在为临床工作中如何提高透析患者的生存质量提供依据。方法①选择行规律持续非卧床腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）治疗6个月以上的109例慢性肾衰竭患者。收集患者的民族、年龄、性别、原发病因、受教育程度、年均收入、透析时间、透析方案及体质量指数（body mass index,BMI）等资料。按民族分为回族组和汉族组。②采用肾脏疾病生活质量简表（Medical Outcomes Study Health Status ShortForm,SF-36）评估患者的生活质量。③采用肾脏病膳食改良实验（Modifi—cationofDietinRenalDisease,MDI①）方程估计算患者的肾小球滤过率,以评估患者的残余肾功能。④采用主观综合性营养评估（subjective global assessment,SGA）及白蛋白等指标评估患者营养状况。⑤采用Charlson合并症指数评估患者合并症情况。⑥检测患者血浆全段甲状旁腺素（intactparathy—roidhormone,iPTH）及血钙、血磷水平以评估患者的钙磷代谢状况。结果①回族组、汉族组患者在年龄、性别、原发病因、受教育程度、年均收入、透析时间、透析方案及Charlson合并症指数等均无统计学差异（P〉0．05）。②与汉族组比较,回族组患者血钙、白蛋白、三酰甘油、总胆固醇及肾小球滤过率明显降低,iPTH水平明显升高,差异有统计学意义（P〈0．05）。③与汉族组比较,回族组的SGA评估的营养不良的发生率亦明显升高（47．5Z比24．6％）,有统计学差异（P〈O．05）。④与汉族组比较,回族组在SF-36评分[（52．90±20．68）比（42．78±19．46）]、生理健康评分[（53．27±22．91）比（39．47±20．22）]、精神健康评分E（58．30±22．68）比（46．10±22．76）]均明显下降,有统计学差异（P〈0．05）。⑤与汉族组比较,回族组在情感与精神状况[-（65．29±19．85）比（54．65±21．60）]和疼痛[（72．54±27．88）比（47．19±30．85）]两个维度评分也明显下降,均有统计学差异（P〈0．05）。⑥将2组存在差异的指标进行单因素相关分析及多元线性回归发现,不同人群和白蛋白水平与SF-36相关。结论回族、汉族腹膜透析患者生活质量SF-36、生理健康及精神健康存在一定的差异,回族患者明显低于汉族;白蛋白水平是影响患者生活质量的因素。     

Relationships between SF-36 health profile and bone mineral density: the Hertfordshire Cohort Study

We utilised the Hertfordshire Cohort Study (HCS) to relate bone mineral density (BMD) to SF-36 health-related quality of life scores. We studied 737 men and 675 women who had completed a home interview and clinic. Four hundred and ninety-eight men and 468 women subsequently attended for bone densitometry [dual-energy X-ray absorptiometry (DXA)]. SF-36 questionnaire responses were mapped to eight domains: physical function (PF), role physical (RP), role emotional (RE), social functioning (SF), mental health (MH), vitality (VT), bodily pain (BP) and general health perception (GH). Subjects with scores in the lowest gender-specific fifth of the distribution were classified as having “poor” status for each domain. Odds ratios (OR) for poor status for each domain were calculated per unit increase in lumbar spine or total femoral BMD t score. Among men after adjustment for age, BMI, social class, lifestyle (including physical activity) and known comorbidity, higher total femoral t score was associated with decreased prevalence of poor SF-36 scores for PF [OR 0.72 (95%CI 0.53, 0.97), p=0.03], SF [OR 0.70 (95%CI 0.53, 0.94), p=0.02] or GH domains [OR 0.74 (95%CI 0.56, 0.99), p=0.05], but no relationships were apparent between SF-36 scores and lumbar spine t score. Among women, the adjusted relationship between higher total femoral t score and decreased prevalence of poor PF was consistent [OR 0.71 (95%CI 0.50, 1.00), p=0.05], but no other relationships were significant. Poorer functioning (assessed by SF-36 questionnaire) is associated with lower total femoral BMD in older men (but less so in women) after adjustment for lifestyle factors and comorbidity.     

Quality of life in osteogenesis imperfecta

The purpose of this study was to quantify the physical and mental health of a diverse adult cohort of patients with osteogenesis imperfecta (OI) utilizing a validated health self-assessment questionnaire (SF-36). In addition, a specific demographic questionnaire and a functional questionnaire were utilized to assess more specifically the physical limitations imposed by osteogenesis imperfecta in adulthood. The results of the SF-36 revealed significantly lower physical function scores compared to the U.S. adult norms. However, the SF-36 mental component scores were equal to the U.S. adult norms. The demographic questionnaire revealed high levels of educational achievement, as well as employment, despite significant physical impairments. The functional questionnaire clearly demonstrated limitations mostly related to ambulation.     

SF-36量表评估心脏瓣膜病患者术后生活质量的研究进展

生活质量评估是从患者主观感受角度评估患者病情,近半个世纪来,逐渐成为临床评价治疗效果的一项重要指标.生活质量评估量表众多,SF-36健康调查简表(the 36-Item Short Form Health Survey,SF-36)是目前应用最广泛的量表.近年来,SF-36量表逐渐应用于探索影响心脏瓣膜病患者术后生活质量的危险因素,为临床医生提供了更多的术前评估方法,提高了手术治疗效果.但目前SF-36用于评估心脏瓣膜病患者生活质量刚刚起步,受样 ,本量、随访时间、地域、文化等因素的影响,结论有一定分歧.为此,我们对目前用SF-36量表评估心脏瓣膜病患者术后生活质量的研究进展进行综述,以更好地应用SF-36量表.     

Predictors of early quality-of-life improvement after laparoscopic gastric bypass surgery

BACKGROUND: Quality of life is getting more attention in the medical literature. Treatment outcomes are now gauged by their effect on quality of life (QOL), along with their direct effect on diseases they are targeting. Similarly, in obesity, consensus has been reached on the importance of QOL as an independent outcome measure for obesity surgery along with weight loss and comorbidity. Therefore, the aim of this study was to assess the impact of patient demographics and comorbidities on short-term QOL improvement after laparoscopic gastric bypass (LGB) surgery. METHODS: The change in QOL after LGB was assessed in 171 patients (147 women, 24 men; mean age, 43.1 y) using the Short-Form-36 (SF-36) questionnaire. Multivariate logistic regression analysis was used to identify patients' demographics and comorbidities predictive of major QOL improvement. RESULTS: Body mass index decreased significantly at 3 months (48.5 +/- 5.8 to 38.4 +/- 5.4 kg/m2; P < .001) with excess weight loss of 37.4% +/- 9.2%. The SF-36 follow-up evaluation showed significant improvement (44.2 +/- 15.7 to 78.6 +/- 15.5; P < .001). A significant inverse correlation was found between QOL (before and after bypass) and the number of comorbidities (r = .29, P = .001; R = .22, P = .005; respectively), but the magnitude of QOL change did not correlate with the number of comorbidities (P = .5). When the entire cohort of patients was dichotomized according to their magnitude of change in SF-36 scores, the univariate analysis showed that the group of patients with no improvement or minor improvement in their SF-36 was characterized by a higher percentage of male sex and a lower prevalence of diabetes. These 2 preoperative factors remained statistically significant in the multivariate analysis. Preoperative diagnosis of type 2 diabetes increased the likelihood of major improvement in QOL after LGB by 6.2 times, whereas being a woman increased this likelihood by 16.1 times. CONCLUSIONS: Significant weight loss was achieved as early as 3 months after LGB, causing substantial improvement in QOL in more than 95% of patients. Women with type 2 diabetes have the highest odds to achieve a major QOL improvement after LGB and therefore they should represent the ideal target population for surgical weight loss programs.     

Evaluation of long term health-related quality of life in extensive burns: a 12-year experience in a burn center

Objectives

We sought to evaluate the long term health-related quality of life (HRQOL) in patients survived severely extensive burn and identify their clinical predicting factors correlated with HRQOL.

Methods

A cross-sectional study was conducted in 20 patients survived more than 2 years with extensive burn involving ≥70% total body surface area (TBSA) between 1997 and 2009 in a burn center in Shanghai. Short Form-36 Medical Outcomes Survey (SF-36), Brief Version of Burn Specific Health Scale (BSHS-B) and Michigan Hand Outcome Questionnaire (MHQ) were used for the present evaluation. SF-36 scores were compared with a healthy Chinese population, and linear correlation analysis was performed to screen the clinical relating factors predicting physical and mental component summary (PCS and MCS) scores from SF-36.

Results

HRQOL scores from SF-36 were significantly lower in the domains of physical functioning, role limitations due to physical problems, pain, social functioning and role limitations due to emotional problems compared with population norms. Multiple linear regression analysis demonstrated that only return to work (RTW) predicted improved PCS. While age at injury, facial burns, skin grafting and length of hospital stay were correlated with MCS. Work, body image and heat sensitivity obtained the lowest BSHS-B scores in all 9 domains. Improvements of HRQOL could still be seen in BSHS-B scores in domains of simple abilities, hand function, work and affect even after a quite long interval between burns and testing. Hand function of extensive burn patients obtained relatively poor MHQ scores, especially in those without RTW.

Conclusions

Patients with extensive burns have a poorer quality of life compared with that of general population. Relatively poor physical and psychological problems still exist even after a long period. Meanwhile, a trend of gradual improvements was noted. This information will aid clinicians in decision-making of comprehensive systematic regimens for long term rehabilitation and psychosocial treatment.     

A meta-analysis of amputation versus limb salvage in mangled lower limb injuries—The patient perspective

This meta-analysis evaluates the quality of life in post-traumatic amputees in comparison with limb salvage. Studies included in this meta-analysis had a minimum of 24 months of follow-up and used a validated quality-of-life outcome assessment scale (Short Form-36 or Sickness Impact Profile) for physical and psychological outcomes. Two reviewers performed the search and data extraction independent of each other.A total of 214 studies were identified; 11 fulfilled the inclusion criteria; thus, 1138 patients were available for meta-analysis (769 amputees and 369 cases of reconstruction).The meta-analysis demonstrated that lower limb reconstruction is more acceptable psychologically to patients with severe lower limb trauma compared with amputation, even though the physical outcome for both management pathways was more or less the same.     

The Influence of Surgical Approach on Quality of Life After Parathyroid Surgery

Background It is well established that quality of life improves after parathyroidectomy. Less well understood is the impact of surgical approach on quality of life during recovery. This study was undertaken to determine whether surgical approach influences quality of life after surgery for hyperparathyroidism. Methods A total of 146 consecutive patients who underwent surgery for hyperparathyroidism were administered the SF-36 Health Survey 1 week before, 1 week after, and 1 year after surgery. Results Ninety-eight patients had minimally invasive parathyroidectomies, while 48 patients had bilateral explorations. All patients were normocalcemic >6 months after surgery. Hospital length of stay was significantly shorter in those undergoing a minimally invasive operation (mean ± SE, .2 ± .0 vs. .9 ± .0 days, P <.001). The rate of complications was not statistically different (3.1% vs. 6.3%, P = .40). Quality of life improved after surgery for hyperparathyroidism, irrespective of surgical approach. The minimally invasive group greatly improved in four scales 1 week after operation, while those with a bilateral exploration improved in two. After 1 year, the minimally invasive group had statistically improved in eight categories, while the bilateral exploration group did so in only four (P <.05 for all). Conclusions With improvements in surgical outcomes and quality of life, these data provide additional evidence that minimally invasive parathyroidectomy is the operation of choice for patients with hyperparathyroidism.     

老年腹膜透析患者生存质量的影响因素

目的 探讨持续不卧床腹膜透析(CAPD)老年患者的生存质量状况,并初步探讨影响老年CAPD患者生存质量的各种因素.方法 选取我院2011年至2014年4月期间收治的年龄大于60岁的行持续不卧床腹膜透析治疗的63例老年患者,按年龄分为＜70岁和≥70岁两组,使用SF-36量表调查患者的生存质量.结果 两组患者年龄[(63.93±2.97)vs(73.57±3.22)岁]、Charlson合并症指数(3.4+±2.3 vs 5.0± 3.1)、Karnofsky活动指数(82±9 vs72± 16)、合并心血管并发症(x2=9.921,P=0.002)差异有统计学意义(均P＜0.05).两组患者SF-36量表中8个维度比较差异无统计学意义(均P＞ 0.05);在躯体健康相关生存质量方面差异有统计学意义(P=0.031).相关性分析显示,SF-36总分与Kamofsky活动指数(r=0.046,P=0.000)、残肾功能(r=0.314,P=0.012)呈正相关;与焦虑指数(r=-0.318,P=0.014)、抑郁指数(r=-0.341,P=0.006)呈负相关.躯体健康相关生存质量与年龄(r=-0.337,P=0.007)、是否合并心血管并发症(r=-0.333,P=0.008)、抑郁指数(r=-0.369,P=0.003)呈负相关;与Karnofsky活动指数(r=0.507,P=0.000)、残余肾功能(r=0.268,P=0.034)呈正相关性.精神健康相关生存质量与焦虑指数(r=-0.327,P=0.009)、抑郁指数(r=-0.267,P=0.034)呈负相关;与Karnofsky活动指数(r =0.321,P=0.01)、残余肾功能(r=0.283,P=0.025)呈正相关.结论 对于老年腹膜透析患者而言,年龄、焦虑指数、抑郁指数、Karnofsky活动指数、残肾功能、心血管并发症的发生都可能会影响其生存质量.     

脊髓型颈椎病患者术后神经功能与生活质量的变化及其之间的相关性分析

目的:分析脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者术后生活质量的康复规律及其与神经功能康复的相关性。方法:收集北京大学第三医院骨科2008年2月~2013年5月收治的280例诊断为CSM并接受手术治疗患者的资料。术前使用改良JOA评分(mJOA评分)评价患者的神经功能,使用SF-36评价患者的生活质量,在术后3个月、1年和末次随访时使用上述两项评价方法对患者进行连续性随访。采用Wilcoxon rank-sum检验探讨患者神经功能及生活质量的变化规律,采用Spearman相关检验探讨生活质量与神经功能康复的相关性,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价mJOA评分的变化值、mJOA评分的改善率、SF-36的生理维度(PCS)及心理维度(MCS)四项指标对于患者主观评价健康变化(health transition item,HTI)的判断价值,使用ROC曲线下面积(area under the curve,AUC)评价ROC曲线的准确性,同时用Spearman相关检验进一步探讨四个指标对于HTI的敏感性及可靠性。结果:随访50.5±10.3个月(24~84个月)。术后3个月、1年和末次随访时的神经功能改善率分别为(45.0±42.4)%、(64.4±31.6)%和(66.8±36.9)%。在SF-36的各个维度上,患者手术前的评分均较正常人群有不同程度的下降(P0.05);术后3个月时,除了总体健康(GH)和社会功能(SF)两项外,其他各维度均有显著改善(P0.05);术后1年以及末次随访时,SF-36的8个维度均有显著改善(P0.05)。术后3个月时,只有PCS有显著改善(P=0.000),而MCS则较术前无明显变化(P=0.103);术后1年及末次随访时PCS及MCS均有显著改善(P0.05)。术后3个月、1年和末次随访时的HTI分别为2.27±1.06、1.84±0.90和1.84±0.88。在术后3个月时,只有PCS改善与神经功能改善显著相关(P0.05);术后1年与末次随访时,PCS及MCS的改善均与神经功能改善相关(P0.05)。术后3个月时SF-36的PCS对于HTI的判别价值最高(AUC=0.97,相关系数=-0.81);术后1年时为mJOA评分改善率(AUC=0.93,相关系数=-0.82);末次随访时SF-36的MCS与HTI的相关性最高(相关系数=-0.67),而mJOA评分改善率与HTI的AUC最大(AUC=0.95)。结论:CSM患者术后神经功能和生活质量显著改善;神经功能改善早期只与PCS相关,中期则与PCS和MCS两个方面相关;随着CSM患者术后随访时间的变化,判别患者主观评价最有效的指标是不同的。     

Long-term functional and quality of live assessment following post-traumatic distraction osteogenesis of the lower limb

Limb length discrepancy and segmental bone defects can be difficult problems to manage after fractures of the lower limb. Distraction osteogenesis can be applied to lengthen bone or to bridge intercalary defects by segmental bone transport. The purpose of this study was to assess the functional outcome and long-term quality of life after distraction osteogenesis of the lower limb when applied for post-traumatic problems. Three patients were treated with segmental transport for bone loss secondary to infection and debridement after a tibia fracture. Leg lengthening was performed in 12 patients with consolidated fractures (eight femurs and four tibias). Long-term functional outcomes were evaluated with the Short Form-36 Health Survey (SF-36) and the Lower Extremity Functional Scale (LEFS) in all patients. The mean follow-up was 9 years. Functional outcomes indicated moderate difficulty in patients after segmental transport and a little difficulty in patients after lengthening of consolidated fractures. The SF-36 scores varied two points for physical functioning and one point for bodily pain as compared to the SF-36 norm-based scores. In all other six domains, patient scores were comparable with the general population. In conclusion, the quality of life and functional outcome returned to normal after post-traumatic distraction osteogenesis of the lower limb.     

Comparison between a general and a disease-specific health-related quality-of-life questionnaire in patients after pancreatic surgery

Background/Purpose The aim of this study was to compare the short-form (SF-) 36 as a general instrument and the gastrointestinal quality of life index (GIQLI) as a disease-specific instrument in patients after pancreatic surgery.Methods The questionnaires were sent to patients receiving pancreatic surgery over a time period of three years. Patients were compared with a normal population completing the SF-36 or reported normal-population values for the GIQLI. Agreement between the instruments was analyzed using Bland Altman plots.Results A total of 98 patients were included, most of them undergoing a Whipple procedure (86%). The most frequent complaints were meteorism, obstipation, stool urgency, and stress incontinence in 9% of the patients. Whereas in almost every domain of the SF-36 the HRQL was impaired in comparison to the normal population, the GIQLI showed differences in only the domain emotions. Neither the SF-36 nor the GIQLI was different between patients with early and advanced cancer stages. The SF-36 had no agreement with the GIQLI.Conclusions The results of HRQL studies depend on the instruments which were used. Whereas a general instrument may detect factors such as comorbidity more accurately, disease-specific instruments have the advantage of better clinical interpretability.Presented at the 120th Congress of the German Society for Surgery, Munich, May 2003     

Distress from lower urinary tract symptoms and its effect on the quality of life in Swedish men

BackgroundLower urinary tract symptoms (LUTS) are common in men and while symptoms have been described as being associated with distress, less attention has been paid to Quality of Life (QoL). The aim of this study was to describe how distress from LUTS affects QoL in men.MethodsThe study included 1008, 40–80 year-old, men living in a municipality in Sweden. Participants completed the SF-36 Health Survey and the Danish Prostatic Symptom Score (DAN-PSS). The SF-36 questionnaire measures health status in eight general areas and the DAN-PSS questionnaire measures severity, frequency and distress resulting from LUTS.ResultsIn all, 63% of the men reported that they experienced some degree of distress related to LUTS. The mean SF-36 scores were significantly lower in all the dimensions evaluated among men who experienced low distress from nocturia, daytime frequency, straining and post micturition dribbling than among men without distress from these symptoms. Furthermore, men with low distress from weak stream reported lower SF-36 scores for all evaluated dimensions except for physical functioning (PF) than men without distress from weak stream. Men with moderate/major distress from incomplete emptying had a decreased QoL compared to men with low distress from incomplete emptying.ConclusionsDistress from lower urinary tract symptoms reduced QoL in men. Even when low distress is experienced, QoL is reduced. Identification of the distress impact on QoL is warranted to restore QoL, but also to identify optimal treatment.     

SF-36量表评价胸外科住院患者生活质量的信度和效度

目的 评价SF-36量表用于特定区域医学中心胸外科住院患者生活质量的信度和效度,以帮助该群体治疗和护理计划的制定。 方法 选取在2012年3～5月期间就诊于华西医院胸外科的患者95例,其中有效问卷94例,男68例、女26例,平均年龄 （62.0±13.0） 岁,术前诊断：肺鳞癌8例,肺腺癌6例,肺小细胞癌1例,食管癌12例,不明性质肺肿块67例。术后诊断：肺鳞癌39例,肺腺癌28例,肺小细胞癌8例,食管癌12例,肺结核3例,肺炎性假瘤4例。以SF-36量表中文版作为生活质量评价工具,以Cronbach＇s α系数和分半信度评价其信度,因子分析评价其效度。 结果 SF-36量表测量的各维度Cronbach＇s α系数为生理机能 （PF） 0.873,生理职能 （RP） 0.859,躯体疼痛 （BP） 0.888,一般健康状况 （GH） 0.721,精力 （VT） 0.899,社会职能 （SF） 0.852,情感职能 （RE） 0.872,精神健康 （MH） 0.598,分半信度系数为生理机能 （PF） 0.725,生理职能 （RP） 0.784,躯体疼痛 （BP） 0.789,一般健康状况 （GH） 0.758,精力 （VT） 0.749,社会职能 （SF） 0.745,情感职能 （RE） 0.740,精神健康 （MH） 0.426,结构效度检验共提取9个公因子,基本反映了量表的8个维度,与量表的结构构思基本相符。 结论 SF-36量表用于评价胸外科住院患者生活质量具有可靠的信度和效度。     

Relief of Dysphagia after Laparoscopic Heller Myotomy Improves Long-Term Quality of Life

Background and Objective  Quality of life (QoL) is getting more attention in the medical literature. Treatment outcomes are now gauged by their effect on the QoL along with their direct effect on the diseases they are targeting. The aim of the study was to assess the impact of residual dysphagia on QoL after laparoscopic Heller myotomy for achalasia. Methods  QoL was evaluated using the short-form-36 (SF-36) and postoperative dysphagia was assessed using a dysphagia score. The score (range 0–10) was calculated by combining the frequency of dysphagia (0=never, 1 = < 1 day/wk, 2 = 1 day/wk, 3 = 2–3 days/wk, 4 = 4–6 days/wk, 5=daily) with the severity (0=none, 1=very mild, 2=mild, 3=moderate, 4=moderately severe, 5=severe). Patients were classified in the Nonresponder group when their dysphagia score was in the upper quartile. Results  Questionnaires were mailed to 110 patients. The overall response rate was 91% with 100 patients (54 female) returning the questionnaires. The average follow-up was 3.3 years. There was a significative inverse correlation between dysphagia score and mental component (P = 0.0001) and total SF-36 (P = 0.001) scores. According to their postoperative dysphagia scores, 77 patients were assigned to the Responder Group and 23 patients to the Nonresponder Group. The two groups were similar in terms of age, gender, rate of fundoplication, and length of follow-up. Mental component and total SF-36 scores were significantly (P < 0.05) higher in the Responder group. Successful relief of dysphagia after Heller myotomy was associated with health-related quality of life scores that were 13 higher in Vitality (P < 0.05), 11 points higher in mental health (P < 0.05), and 12 points higher in General Health (P < 0.05). Overall patient satisfaction with surgical outcome was 92%, with only eight patients not satisfied with the surgery. Conclusion  Laparoscopic Heller myotomy offers excellent long-term relief of achalasia-related symptoms, namely dysphagia, and this was projected on a significant improvement in quality of life and patient satisfaction. Presented at the 47th annual meeting at Digestive Disease Week 2006