Rothenhäusler H-B, Stepan A, Hetterle R, Trantina-Yates A
Universitätsklinik für Psychiatrie, Medizinische Universität Graz.
Fortschr Neurol Psychiatr. 2010 Jun;78(6):343-54. doi: 10.1055/s-0029-1245298. Epub 2010 Mar 24.
The success of routine coronary artery bypass graft surgery (CABG) is now no longer judged solely by its effects on traditional end points such as mortality rates but by its influence on biopsychosocial dimensions. The aim of this study was to assess the course of health-related quality of life, cognitive and emotional change during the six months after elective CABG, and to investigate how cognitive impairments, depression and posttraumatic stress symptoms were related to quality of life. In a prospective study, we followed up for 6 months 138 of the original 147 patients who had undergone elective CABG surgery. Preoperatively, and at 6 months after surgery, a series of psychometric observer-rating and self-rating scales were administered to evaluate cognitive functioning (SKT), depressive symptoms (BDI), posttraumatic stress symptoms (PTSS-10), and health-related quality of life (SF-36 Health Status Questionnaire). The measurements of health-related quality of life (HRQOL) indicated significantly higher SF-36 values on all of the eight health-related domains from preoperative to 6-month follow-up assessments. However, at 6-month follow-up, patients with clinical depression had significantly lower SF-36 values on all of the eight health-related domains when compared with patients without depression. Also, at 6-month follow-up, patients with posttraumatic stress disorder (PTSD) had significantly lower SF-36 values on six of the eight SF-36 health categories when compared with patients without PTSD. Finally, at 6-month follow-up, patients with cognitive deficits had significantly lower SF-36 values on physical functioning when compared with patients without cognitive impairments. We underscore the need for early and comprehensive bio-psycho-social diagnosis and therapy of post-CABG patients in order to treat emotional distress and CABG-related cognitive impairments and enhance patients' quality of life at an early stage after cardiac surgery.
常规冠状动脉旁路移植术（CABG）的成功如今不再仅依据其对传统终点指标（如死亡率）的影响来评判，而是取决于其对生物心理社会层面的作用。本研究旨在评估择期CABG术后六个月内与健康相关的生活质量、认知及情绪变化的过程，并探究认知障碍、抑郁和创伤后应激症状与生活质量之间的关系。在一项前瞻性研究中，我们对最初接受择期CABG手术的147例患者中的138例进行了为期6个月的随访。术前及术后6个月，采用一系列心理测量的观察者评分和自评量表来评估认知功能（SKT）、抑郁症状（BDI）、创伤后应激症状（PTSS - 10）以及与健康相关的生活质量（SF - 36健康状况问卷）。与健康相关的生活质量（HRQOL）测量结果显示，从术前到6个月随访评估，在所有八个与健康相关的领域中，SF - 36值均显著升高。然而，在6个月随访时，与无抑郁的患者相比，临床抑郁患者在所有八个与健康相关的领域中的SF - 36值均显著较低。此外，在6个月随访时，与无创伤后应激障碍（PTSD）的患者相比，患有PTSD的患者在八个SF - 36健康类别中的六个类别中的SF - 36值显著较低。最后，在6个月随访时，与无认知障碍的患者相比，有认知缺陷的患者在身体功能方面的SF - 36值显著较低。我们强调，需要对CABG术后患者进行早期和全面的生物心理社会诊断及治疗，以治疗情绪困扰和CABG相关的认知障碍，并在心脏手术后早期提高患者的生活质量。
