Järvinen Otso, Hokkanen Matti, Huhtala Heini
Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland.
Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland.
Int J Angiol. 2019 Mar;28(1):50-56. doi: 10.1055/s-0038-1676791. Epub 2019 Jan 2.
A prevalence of diabetes is increasing among the patients undergoing coronary artery bypass grafting (CABG). Data on whether health-related quality of life improves similarly after CABG in diabetics and nondiabetics are limited. We assessed long-term mortality and changes in quality of life (RAND-36 Health Survey) after CABG. Seventy-four of the 508 patients (14.6%) operated on in a single institution had a history of diabetes and were compared with nondiabetics. The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 1 and 12 years later. Thirty-day mortality was 2.7 versus 1.6 ( = 0.511) in the diabetics and nondiabetics. One- and 10-year survival rates in the diabetics and nondiabetics were 94.6% versus 97.0% ( = 0.287) and 63.5% versus 81.6% ( < 0.001), respectively. After 1 year, diabetics improved significantly ( < 0.005) in seven, and nondiabetics ( < 0.001) in all eight RAND-36 dimensions. Despite an ongoing decline in quality of life over the 12-year follow-up, an improvement was maintained in four out of eight dimensions among diabetics and in seven dimensions among nondiabetics. Physical and mental component summary scores on the RAND-36 improved significantly ( < 0.001) in both groups after 1 year, and at least slight improvement was maintained during the 12-year follow-up time. Diabetics have inferior long-term survival after CABG as compared with nondiabetics. They gain similar improvement of quality of life in 1 year after surgery, but they have a stronger decline tendency over the years.
在接受冠状动脉旁路移植术（CABG）的患者中，糖尿病的患病率正在上升。关于糖尿病患者和非糖尿病患者在CABG后健康相关生活质量是否以相似方式改善的数据有限。我们评估了CABG后的长期死亡率和生活质量变化（RAND-36健康调查）。在一家单一机构接受手术的508例患者中有74例（14.6%）有糖尿病史，并与非糖尿病患者进行了比较。RAND-36健康调查被用作生活质量的指标。术前进行评估，并在1年和12年后重复评估。糖尿病患者和非糖尿病患者的30天死亡率分别为2.7%和1.6%（P = 0.511）。糖尿病患者和非糖尿病患者的1年和10年生存率分别为94.6%对97.0%（P = 0.287）和63.5%对81.6%（P < 0.001）。1年后，糖尿病患者在RAND-36的七个维度上有显著改善（P < 0.005），非糖尿病患者在所有八个维度上有显著改善（P < 0.001）。尽管在12年的随访中生活质量持续下降，但糖尿病患者在八个维度中的四个维度上保持了改善，非糖尿病患者在七个维度上保持了改善。两组在1年后RAND-36的身体和心理成分总结得分均有显著改善（P < 0.001），并且在12年的随访期间至少保持了轻微改善。与非糖尿病患者相比，糖尿病患者在CABG后的长期生存率较低。他们在术后1年获得了相似的生活质量改善，但多年来下降趋势更强。
