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糖尿病患者冠状动脉旁路移植术后长期生存率及生活质量较差。

Diabetics have Inferior Long-Term Survival and Quality of Life after CABG.

作者信息

Järvinen Otso, Hokkanen Matti, Huhtala Heini

机构信息

Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital, Tampere, Finland.

Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland.

出版信息

Int J Angiol. 2019 Mar;28(1):50-56. doi: 10.1055/s-0038-1676791. Epub 2019 Jan 2.

Abstract

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.

摘要

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。

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