老年重症肢体缺血患者生活质量与健康状况的重要差异。
Important differences between quality of life and health status in elderly patients suffering from critical limb ischemia.
机构信息
Department of Surgery, Amphia Hospital, Breda, The Netherlands.
Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
出版信息
Clin Interv Aging. 2019 Jul 8;14:1221-1226. doi: 10.2147/CIA.S202725. eCollection 2019.
INTRODUCTION
Critical limb ischemia (CLI) patients are often of advanced age with reduced health status (HS) and quality of life (QoL) at baseline. Physical health is considered as the most affected domain due to reduced mobility and ischemic pain. QoL and HS are often used interchangeably in the current literature. HS refers to objectively perceived physical, psychological, and social functioning and in assessing QoL, change is measured subjectively and can only be determined by the individual since it concerns patients' evaluation of their functioning. It is important to distinguish between QoL and HS, especially in the concept of shared decision-making when the opinion of the patient is key. Goal of this study was to examine and compare QoL and HS in elderly CLI patients in relation to the used therapy, with a special interest in conservatively treated patients.
METHODS
Patients suffering from CLI and ≥70 years old were included in a prospective study with a follow-up period of 1 year. Patients were divided into three groups; endovascular revascularization, surgical revascularization, and conservative therapy. The WHOQoL-Bref was used to determine QoL, and the 12-Item Short Form Health Survey was used to evaluate HS at baseline, 5-7 days, 6 weeks, 6 months, and 1 year.
RESULTS
Physical QoL of endovascularly and surgically treated patients showed immediate significant improvement during follow-up in contrast to delayed increased physical HS at 6 weeks and 6 months (<0.001). Conservatively treated patients showed significantly improved physical QoL at 6 and 12 months (=0.02) in contrast to no significant improvement in physical HS.
CONCLUSION
This study demonstrates that QoL and HS are indeed not identical concepts and that differentiating between these two concepts could influence the choice of treatment in elderly CLI patients. Discriminating between QoL and HS is, therefore, of major importance for clinical practice, especially to achieve shared decision-making.
简介
严重肢体缺血（CLI）患者通常年龄较大，基线时健康状况（HS）和生活质量（QoL）较差。由于活动能力下降和缺血性疼痛，身体健康被认为是受影响最严重的领域。在当前文献中，QoL 和 HS 经常互换使用。HS 是指客观感知的身体、心理和社会功能，在评估 QoL 时，变化是主观测量的，只能由个体确定，因为它涉及患者对自身功能的评估。区分 QoL 和 HS 很重要，特别是在患者意见至关重要的共同决策概念中。本研究的目的是检查和比较老年 CLI 患者的 QoL 和 HS 与所使用的治疗方法之间的关系，特别关注保守治疗的患者。
方法
患有 CLI 且年龄≥70 岁的患者被纳入一项前瞻性研究，随访期为 1 年。患者分为三组：血管内血运重建、手术血运重建和保守治疗。使用 WHOQoL-Bref 来确定 QoL，使用 12 项简短健康调查来评估基线、5-7 天、6 周、6 个月和 1 年的 HS。
结果
血管内和手术治疗患者的身体 QoL 在随访期间立即显著改善，而身体 HS 在 6 周和 6 个月时延迟增加（<0.001）。保守治疗患者在 6 个月和 12 个月时身体 QoL 显著改善（=0.02），而身体 HS 无显著改善。
结论
本研究表明，QoL 和 HS 确实不是同一概念，区分这两个概念可能会影响老年 CLI 患者的治疗选择。因此，区分 QoL 和 HS 对于临床实践非常重要，特别是为了实现共同决策。
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