Silesian Medical University, Katowice, Poland.
Kardiol Pol. 2009 Oct;67(10):1078-85.
The impact of coronary artery bypass grafting (CABG) on the quality of life (QoL) is one of the important measures of the efficacy of the procedure. This issue in young, professionally active male patients has not been extensively studied.
To assess QoL before and after on-pump CABG, and before and after cardiac rehabilitation in young men with low operative risk.
The study group comprised 50 men aged 54.4 +/- 5.6 years who were professionally active before the surgery. The QoL was assessed on the basis of the MacNew questionnaire (in points). We analysed QoL changes and effects of basic demographic and peri-operative data on QoL during a short-term follow-up.
All components of QoL deteriorated shortly after CABG: emotional - from 4.97 +/- 0.96 to 4.66 +/- 1.0 (p = 0.03); physical - from 4.49 +/- 1.1 to 4.2 +/- 1.2 (p = 0.02); and social - from 4.68 +/- 1.0 to 4.47 +/- 1.1 (p = 0.1). Pre-operative physical and social QoL positively correlated with age (r = 0.45 and r = 0.37, respectively) and left ventricular ejection fraction (LVEF) (r = 0.49 and r = 0.48, respectively). However, there was a negative impact of history of myocardial infarction on physical QoL (p < 0.05). A negative influence of cardiopulmonary bypass time (r = -0.45) and cross-aortic clamp time (r = -0.36) on physical QoL was also noted. The QoL values were also influenced by class of angina symptoms (R = -0.33 / -0.42), total drainage (r = -0.11 / -0.34) and quantity of grafts (R = -0.35 / -0.42). During rehabilitation, QoL significantly improved: emotional - from 5.29 +/- 0.92 to 5.96 +/- 0.9 (p = 0.01); physical - from 4.66 +/- 1.1 to 5.42 +/- 1.2 (p < 0.01); and social - from 4.69 +/- 1.2 to 5.65 +/- 1.1 (p < 0.01). The QoL during rehabilitation was correlated with baseline peri-operative risk (for logistic EuroSCORE algorithm r = -0.21 / -0.31 and for EuroSCORE R = -0.47 / -0.89). Significant determinants of some components of QoL were also LVEF (r= 0.26 / 0.47), morphological blood parameters (r = 0.37 / 0.43), baseline CCS class (R = 0.31 / 0.58), age (r = -0.41 / -0.83), and extent of surgery defined by cardiopulmonary bypass time, cross-aortic clamp duration and total drainage.
Quality of life in young, professionally active men significantly deteriorates a few days after on-pump CABG but systematically improves during the next weeks, particularly after rehabilitation. Pre-operative QoL correlates positively with age and LVEF, and negatively with a history of myocardial infarction. Age, pre-operative risk, angina symptoms and the extent of surgery have negative effects on physical QoL after CABG during short-term observation.
体外循环冠状动脉旁路移植术（CABG）对生活质量（QoL）的影响是该手术疗效的重要衡量标准之一。在年轻、职业活跃的男性患者中，这一问题尚未得到广泛研究。
评估低手术风险的年轻男性患者行体外循环 CABG 术前、术后及心脏康复后的生活质量。
研究组纳入了 50 名年龄 54.4±5.6 岁的职业活跃男性患者。使用 MacNew 问卷（以分数表示）评估 QoL。我们分析了 QoL 变化以及基本人口统计学和围手术期数据对短期随访期间 QoL 的影响。
CABG 后所有 QoL 指标均恶化：情感方面，从 4.97±0.96 降至 4.66±1.0（p=0.03）；身体方面，从 4.49±1.1 降至 4.2±1.2（p=0.02）；社会方面，从 4.68±1.0 降至 4.47±1.1（p=0.1）。术前的身体和社会 QoL 与年龄（r=0.45 和 r=0.37）和左心室射血分数（LVEF）（r=0.49 和 r=0.48）呈正相关。然而，心肌梗死史对身体 QoL 有负面影响（p<0.05）。体外循环时间（r=-0.45）和主动脉夹闭时间（r=-0.36）对身体 QoL 也有负面影响。QoL 值还受到心绞痛症状分级（R=-0.33/-0.42）、总引流量（r=-0.11/-0.34）和移植血管数量（R=-0.35/-0.42）的影响。在康复期间，QoL 显著改善：情感方面，从 5.29±0.92 升至 5.96±0.9（p=0.01）；身体方面，从 4.66±1.1 升至 5.42±1.2（p<0.01）；社会方面，从 4.69±1.2 升至 5.65±1.1（p<0.01）。康复期间的 QoL 与围手术期基线风险（对于逻辑 EuroSCORE 算法，r=-0.21/-0.31；对于 EuroSCORE，r=-0.47/-0.89）相关。一些 QoL 指标的显著决定因素还包括 LVEF（r=0.26/0.47）、形态学血液参数（r=0.37/0.43）、基线 CCS 分级（R=0.31/0.58）、年龄（r=-0.41/ -0.83）以及由体外循环时间、主动脉夹闭时间和总引流量定义的手术范围。
体外循环 CABG 后几天，年轻、职业活跃的男性患者的生活质量显著下降，但在接下来的几周内会系统改善，特别是在康复后。术前 QoL 与年龄和 LVEF 呈正相关，与心肌梗死史呈负相关。在短期观察期间，年龄、术前风险、心绞痛症状和手术范围对 CABG 后身体 QoL 有负面影响。
