急性冠状动脉综合征患者不同血运重构治疗后生活质量的评价

调查急性冠状动脉综合征患者6个月生活质量变化,并了解冠状动脉介入(PCI)和冠状动脉搭桥(CABG)治疗对患者生活质量影响,为提高急性冠状动脉综合征患者生活质量提供依据。方法:收集北京安贞医院2008年7月至2011年12月就诊患者中符合急性冠状动脉综合征诊断,以及多支病变适于冠状动脉支架置入术或冠状动脉搭桥术患者共1 012例,随机将患者PCI组(n=510)和CABG组(n=502),对患者进行6个月随访。使用西雅图心绞痛量表(SAQ)对患者就诊时和6个月的生活质量进行评估。6个月后总结2组患者生活质量变化,以及影响因素与生活质量变化的关系。结果:6个月后,2组治疗方法患者生活质量均较前明显改善(P<0.001),西雅图心绞痛量表5项分数均有明显提高。6个月时,生活质量分数中躯体活动受限程度(PL)部分,PCI和CABG差异无统计学意义(P>0.05)。其余4部分分数,CABG均优于冠状动脉介入组。在改善比率方面经比较CABG组在躯体受限程度(P<0.05)、心绞痛发作频率(P<0.05)和治疗满意程度(P<0.016)3项中优于PCI组。结论:以SAQ量表作为标准,PCI和CABG可以使生活质量明显改善,CABG组在躯体受限程度、心绞痛发作频率和治疗满意程度3项改善优于PCI组(P<0.05)。

Health-related quality of life in acute coronary syndrome after PCI and CABG

Objective:The aim of the study was to identify the changes in Health Related Quality of Life(HRQL) 6 months after discharge from hospital,in patients who have had an acute coronary episode,and to determine the clinical and treatment variables that explain those changes.Methods: HRQL was assessed in patients while they were admitted to the hospital and at 6 months after discharge,using the Seattle angina questionnaire.To identify PCI and CABG associated with the change,logistic regression models were constructed for five summary dimensions of the Seattle angina questionnaire taking the change in the score of the dimension as dependent variable.Results: Using the Seattle angina questionnaire scores,all three treatment groups experienced relief of angina at the 6-month visit compared with baseline.At 6 months,PCI group and CABG group have more significant improvements(P<0.001).CABG group has more significant improvements than PCI group in physical limitation(P<0.05),angina frequency(P<0.05),treatment satisfaction(P<0.016).Conclusion: In patients with ACS,PCI and CABG can provide greater gain in quality life,CABG improved quality life more in physical limitation,angina frequency,treatment satisfaction.