Phillips-Bute Barbara, Mathew Joseph P, Blumenthal James A, Grocott Hilary P, Laskowitz Daniel T, Jones Robert H, Mark Daniel B, Newman Mark F
Department of Anesthesiology, Box 3094, DUMC, Duke University Medical Center, Durham, North Carolina 27710, USA.
Psychosom Med. 2006 May-Jun;68(3):369-75. doi: 10.1097/01.psy.0000221272.77984.e2.
Although coronary artery bypass grafting (CABG) has been shown to improve quality of life and functional capacity for many patients, recent studies have demonstrated that a significant number of patients exhibit impairment in cognitive function immediately following surgery and beyond. We sought to determine the impact of this postoperative cognitive dysfunction on quality of life (QOL) and to characterize the dysfunction from the patient's perspective.
With Institutional Review Board (IRB) approval and written informed consent, 732 patients at Duke University Hospital undergoing CABG were enrolled. Five hundred fifty-one (75%) completed baseline, 6-week, and 1-year neurocognitive tests and psychometric measures designed to assess QOL. Neurocognitive status was assessed by a composite cognitive index score representing the mean of the scores in four cognitive domains. Change in QOL was assessed by subtracting baseline from 1-year scores for each of 10 QOL measures. The association between QOL and cognitive dysfunction was investigated using multivariable linear regression analysis.
Cognitive decline limited improvement in QOL, with substantial correlation between change in cognition and change in QOL. One-year QOL measures are associated with both 6-week and 1-year change in cognition (Instrumental Activities of Daily Living, p < .0001; Duke Activity Status Index, p < .02; Cognitive Difficulties, p < .0001; Symptom Limitations, p = .0001; Center for Epidemiologic Study Depression, p < .0001; General Health Perception, p = .0001).
Postoperative cognitive decline may diminish improvements in QOL. Strategies to reduce cognitive decline may allow patients to achieve the maximum improvement in QOL afforded by CABG, as even short-term cognitive dysfunction has implications for QOL 1 year later.
尽管冠状动脉旁路移植术（CABG）已被证明可改善许多患者的生活质量和功能能力，但最近的研究表明，相当数量的患者在手术后即刻及之后会出现认知功能损害。我们试图确定这种术后认知功能障碍对生活质量（QOL）的影响，并从患者的角度对该功能障碍进行特征描述。
在获得机构审查委员会（IRB）批准并取得书面知情同意后，招募了杜克大学医院732例行CABG的患者。551名（75%）患者完成了旨在评估QOL的基线、6周和1年神经认知测试及心理测量指标。通过代表四个认知领域得分均值的综合认知指数评分来评估神经认知状态。通过用10项QOL指标中每项指标的1年得分减去基线得分来评估QOL的变化。使用多变量线性回归分析研究QOL与认知功能障碍之间的关联。
认知功能下降限制了QOL的改善，认知变化与QOL变化之间存在显著相关性。1年QOL指标与6周和1年的认知变化均相关（日常生活工具性活动，p < .0001；杜克活动状态指数，p < .02；认知困难，p < .0001；症状限制，p = .0001；流行病学研究中心抑郁量表，p < .0001；总体健康感知，p = .0001）。
术后认知功能下降可能会削弱QOL的改善。减少认知功能下降的策略可能使患者实现CABG所带来的QOL的最大改善，因为即使是短期的认知功能障碍在1年后也会对QOL产生影响。
