Thornton Everard W, Groom Christina, Fabri Brian M, Fox Mark A, Hallas Claire, Jackson Mark
Department of Psychology, University of Liverpool, Liverpool, United Kingdom.
J Thorac Cardiovasc Surg. 2005 Oct;130(4):1022-7. doi: 10.1016/j.jtcvs.2005.05.020.
Neuropsychologic assessment after coronary artery bypass graft surgery indicates cognitive deficits, but data on their effect on health-related quality of life are relatively sparse. The present study assessed neuropsychologic deficits, self-reported health-related quality of life, and mood, together with proxy rating of patients' activities after bypass surgery. More specifically, the study examines the relationship between these varied outcome measures.
A prospective longitudinal assessment of 71 male patients was performed over a 6-month period: 1 week before surgery and postoperatively at 2 and 6 months. Within-patient change was assessed with the neuropsychologic test battery and procedures recommended by the Consensus Panel, the Short Form-36 to measure self-reported health-related quality of life, and the Hospital Anxiety and Depression Scale questionnaire to assess anxiety and depression. Proxy ratings were documented with the Functional Activities Questionnaire.
Poor preoperative health-related quality of life was largely unrelated to medical variables. Cognitive deficit was found in 42% of patients at 2 months and 22% of patients at 6 months. Physical health-related quality of life improved, but benefit for emotional and social functioning was unconvincing, especially over the short term. Although cognitive deficits were largely unrelated to Short Form-36 health-related quality of life, and only partially related to anxiety and depression, they were associated with proxy ratings of patient functioning.
Physical health-related quality of life benefits were confirmed, but adverse cognitive change and only limited emotional benefit were evident after coronary artery bypass graft surgery. Perceived physical gains are unrelated to any cognitive deficit, but the latter correlated with the emotional status of the patient 6 months after surgery and are of concern to close relatives. These issues should be addressed in patient care.
冠状动脉搭桥手术后的神经心理学评估显示存在认知缺陷，但关于这些缺陷对健康相关生活质量影响的数据相对较少。本研究评估了神经心理学缺陷、自我报告的健康相关生活质量和情绪，以及搭桥手术后患者活动的代理评分。更具体地说，该研究考察了这些不同结果指标之间的关系。
对71名男性患者进行了为期6个月的前瞻性纵向评估：手术前1周以及术后2个月和6个月。使用共识小组推荐的神经心理测试组合和程序、测量自我报告的健康相关生活质量的简短健康调查问卷-36以及评估焦虑和抑郁的医院焦虑抑郁量表问卷来评估患者内部的变化。使用功能活动问卷记录代理评分。
术前较差的健康相关生活质量在很大程度上与医学变量无关。2个月时42%的患者和6个月时22%的患者存在认知缺陷。与身体健康相关的生活质量有所改善，但对情绪和社会功能的益处并不令人信服，尤其是在短期内。尽管认知缺陷在很大程度上与简短健康调查问卷-36健康相关生活质量无关，且仅部分与焦虑和抑郁相关，但它们与患者功能的代理评分相关。
与身体健康相关的生活质量得到改善得到了证实，但冠状动脉搭桥手术后出现了不良的认知变化，情绪改善有限。感知到的身体改善与任何认知缺陷无关，但后者与术后6个月患者的情绪状态相关，并且受到近亲的关注。在患者护理中应解决这些问题。
