综合康复和强化教育方案对行冠状动脉旁路移植术的无保护左主干冠状动脉疾病患者焦虑、抑郁、生活质量和主要不良心脑血管事件的影响。
The effects of a comprehensive rehabilitation and intensive education program on anxiety, depression, quality of life, and major adverse cardiac and cerebrovascular events in unprotected left main coronary artery disease patients who underwent coronary artery bypass grafting.
机构信息
Department of Cardiovascular Surgery, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Harbin, 150001, Heilongjiang, China.
出版信息
Ir J Med Sci. 2020 May;189(2):477-488. doi: 10.1007/s11845-019-02129-x. Epub 2019 Nov 22.
OBJECTIVE
This study aimed to explore the effect of a comprehensive rehabilitation and intensive education (CRIE) program on anxiety, depression, quality of life (QoL), and major adverse cardiac and cerebrovascular events (MACCE) risk in unprotected left main coronary artery disease (ULMCAD) patients who underwent coronary artery bypass grafting (CABG).
METHODS
In total, 300 ULMCAD patients who underwent CABG were randomly assigned to the CRIE group or usual care (UC) group in a 1:1 ratio. During a 12-month intervention, anxiety and depression were evaluated by Hospital Anxiety and Depression Scale (HADS), QoL was evaluated by 12-Item Short-Form Health Survey (SF-12), on discharge day from hospital (M0), and at 3 months after the discharge (M3), M6, and M12. All patients were further followed up until occurrence of MACCE or for an additional 24 months, and MACCE accumulating occurrence rate was calculated.
RESULTS
At M12, HADS-anxiety score and anxiety prevalence (17.3% vs. 29.3%) were decreased in the CRIE group than those in the UC group, meanwhile HADS-depression score and depression prevalence (15.3% vs. 24.7%) were also reduced in the CRIE group than those in the UC group. For QoL, SF-12 Physical Component Summary (PCS) score at M6/M12, and SF-12 PCS score change (M12 - M0) were increased in the CRIE group than those in the UC group; meanwhile, SF-12 Mental Component Summary (MCS) score at M12 and SF-12 PCS score change (M12 - M0) were increased in the CRIE group than those in the UC group as well. Besides, MACCE accumulating occurrence rate was numerically lower in the CRIE group compared with that in the UC group but without statistical significance.
CONCLUSIONS
CRIE is an effective approach in improving anxiety, depression, and QoL in ULMCAD patients who underwent CABG.
目的
本研究旨在探讨综合康复和强化教育（CRIE）方案对行冠状动脉旁路移植术（CABG）的无保护左主干冠状动脉疾病（ULMCAD）患者焦虑、抑郁、生活质量（QoL）和主要不良心脏和脑血管事件（MACCE）风险的影响。
方法
共纳入 300 例行 CABG 的 ULMCAD 患者，按 1:1 比例随机分配至 CRIE 组或常规护理（UC）组。在 12 个月的干预期间，采用医院焦虑抑郁量表（HADS）评估焦虑和抑郁，采用 12 项简明健康调查问卷（SF-12）评估 QoL，分别于出院当天（M0）、出院后 3 个月（M3）、6 个月（M6）和 12 个月（M12）进行评估。所有患者均进行随访，直至发生 MACCE 或随访 24 个月，计算 MACCE 累积发生率。
结果
在 M12 时，CRIE 组的 HADS 焦虑评分和焦虑发生率（17.3% vs. 29.3%）低于 UC 组，同时 CRIE 组的 HADS 抑郁评分和抑郁发生率（15.3% vs. 24.7%）也低于 UC 组。在 QoL 方面，CRIE 组的 SF-12 生理成分综合评分（PCS）在 M6/M12 时更高，SF-12 PCS 评分变化（M12-M0）更大；同时，CRIE 组的 SF-12 心理成分综合评分（MCS）在 M12 时更高，SF-12 PCS 评分变化（M12-M0）也更大。此外，CRIE 组的 MACCE 累积发生率低于 UC 组，但差异无统计学意义。
结论
CRIE 是改善行 CABG 的 ULMCAD 患者焦虑、抑郁和 QoL 的有效方法。
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