Koch Colleen Gorman, Khandwala Farah, Cywinski Jacek B, Ishwaran Hemant, Estafanous Fawzy G, Loop Floyd D, Blackstone Eugene H
Department of Cardiothoracic Anesthesia (G-3), The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
J Thorac Cardiovasc Surg. 2004 Aug;128(2):284-95. doi: 10.1016/j.jtcvs.2003.12.033.
Our objectives were to document the preoperative and postoperative functional status of patients undergoing coronary artery bypass grafting, to examine factors that influence functional recovery, and to determine whether gender differences exist in the preoperative and postoperative functional status with the Duke Activity Status Index.
One thousand eight hundred twenty-five patients undergoing isolated coronary artery bypass grafting had baseline and follow-up quality-of-life surveys. Mean follow-up from baseline to postoperative Duke Activity Status Index was 8.0 months for women and men. The influence of 47 variables, in addition to baseline scores on postoperative functional status, was examined with logistic ordinal modeling. An ordinal model for the follow-up score was determined by means of backward selection, with variables retained if they satisfied the criterion of a P value of less than.05.
Median baseline Duke Activity Status Index scores (women, 21.5; men, 32.2; P <.001) and first follow-up scores (women, 42.7; men, 58.2; P <.001) were lower in women than in men. Patients who were older and those who had chronic obstructive pulmonary disease, myocardial infarction, stroke, diabetes, vascular disease, postoperative serious infection, and return to the operating room had lower postoperative scores. After adjusting for these factors, women still had lower follow-up scores (odds ratio for men, 2.1 [95% confidence interval, 1.7-2.6]; P <.001).
A number of preoperative factors, operative variables, and postoperative events are associated with functional recovery after coronary revascularization. In addition, female gender is associated with more postoperative functional impairment after adjusting for these perioperative variables.
我们的目标是记录接受冠状动脉旁路移植术患者的术前和术后功能状态，研究影响功能恢复的因素，并使用杜克活动状态指数确定术前和术后功能状态是否存在性别差异。
1825例接受单纯冠状动脉旁路移植术的患者进行了基线和随访生活质量调查。女性和男性从基线到术后杜克活动状态指数的平均随访时间为8.0个月。除基线评分外，还使用逻辑序贯模型研究了47个变量对术后功能状态的影响。通过向后选择确定随访评分的序贯模型，如果变量满足P值小于0.05的标准，则予以保留。
女性的杜克活动状态指数基线中位数评分（女性为21.5；男性为32.2；P<0.001）和首次随访评分（女性为42.7；男性为58.2；P<0.001）低于男性。年龄较大、患有慢性阻塞性肺疾病、心肌梗死、中风、糖尿病、血管疾病、术后严重感染以及返回手术室的患者术后评分较低。在对这些因素进行调整后，女性的随访评分仍然较低（男性的优势比为2.1[95%置信区间，1.7 - 2.6]；P<0.001）。
一些术前因素、手术变量和术后事件与冠状动脉血运重建后的功能恢复相关。此外，在调整这些围手术期变量后，女性术后功能障碍更为明显。
