Jokinen Janne J, Hippeläinen Mikko J, Turpeinen Anu K, Pitkänen Otto, Hartikainen Juha E K
Department of Cardiothoracic Surgery, Helsinki University Hospital, Haartmaninkatu 4, PO Box 340, FI-00029 Helsinki, Finland.
J Card Surg. 2010 May;25(3):309-17. doi: 10.1111/j.1540-8191.2010.01017.x. Epub 2010 Mar 10.
Objective outcome measures (i.e., survival, mortality, morbidity, complication rate, symptom recurrence, and need for re-interventions) have long been used as benchmarks for successful cardiac surgery, including coronary artery bypass grafting (CABG). Along with these objectively measurable outcome indicators, acquired improvement by cardiac surgery in subjectively experienced health-related quality of life (HRQoL) has gained importance during the last decade in cardiac surgical research. If an increasing proportion of adult patients referred for CABG are elderly, octogenarians or even nonagenarians, the acquired HRQoL benefit from bypass surgery should be considered to be at least as important an outcome measure as potentially marginal improvement in life expectancy or longevity alone. To achieve the maximal HRQoL benefit and to optimize patient selection, a comprehensive analysis and understanding of contributors that affect pre- and postoperative self-perceived HRQoL is essential. These include patient-related characteristics (e.g., demographics and underlying comorbidities), surgical technique-related factors, and healthcare-related attributes. In this paper we review the randomized controlled trials published during the last ten years to analyze the effect of CABG on HRQoL. Specifically, we focus on the differences between the on-pump and off-pump (OPCAB) bypass techniques, investigate the factors that contribute to post-CABG HRQoL, and study post-CABG HRQoL in elderly patients.
客观结果指标（即生存率、死亡率、发病率、并发症发生率、症状复发率以及再次干预的必要性）长期以来一直被用作心脏手术成功的基准，包括冠状动脉旁路移植术（CABG）。除了这些可客观测量的结果指标外，在过去十年的心脏外科研究中，心脏手术在主观体验的健康相关生活质量（HRQoL）方面所取得的改善也变得愈发重要。如果接受CABG的成年患者中老年人、八旬老人甚至九旬老人的比例不断增加，那么旁路手术所带来的HRQoL益处应被视为与预期寿命或寿命的潜在微小改善同样重要的结果指标。为了实现最大的HRQoL益处并优化患者选择，全面分析和理解影响术前和术后自我感知HRQoL的因素至关重要。这些因素包括患者相关特征（如人口统计学和潜在合并症）、手术技术相关因素以及医疗保健相关属性。在本文中，我们回顾了过去十年发表的随机对照试验，以分析CABG对HRQoL的影响。具体而言，我们关注体外循环和非体外循环（OPCAB）旁路技术之间的差异，研究导致CABG术后HRQoL的因素，并研究老年患者CABG术后的HRQoL。
