Perchinsky M, Henderson C, Jamieson W R, Anderson W N, Lamy A, Lowe N, de Guzman S
University of British Columbia, Vancouver, Canada.
Circulation. 1998 Nov 10;98(19 Suppl):II81-6; discussion II86-7.
The purpose of this study was 3-fold: to compare the quality of life (QOL) in age- and sex-matched patients who received biological and mechanical prosthetic valves in isolated aortic valve replacement, to compare the QOL of patients with aortic valve replacement with the general population, and to compare patients with biological and mechanical prostheses with certain valve-specific questions and relate these responses to overall QOL.
Patient-perceived QOL was evaluated in 200 patients who were sampled from a population of 420 patients (age range 51 to 65 years) who underwent isolated aortic valve replacement in the period of 1986 to 1996. One hundred of the sampled patients had a mechanical valve inserted and an equal number had porcine bioprostheses. Three survey instruments were used to examine perceived QOL: the SF-12 form, a 7-valve specific question form, and the Lamy Smiley Faces form. The response to the questionnaires was 89.5% (179 patients). Patients with mechanical valves were more bothered by valve sounds (P < 0.01) and had a negative correlation (P < 0.01) between valve sound and QOL on the mental scale only. Patients with biological valves were more fearful of the need for reoperation (P < 0.01), but there was no correlation between fear and QOL. The mechanical valve group had a negative correlation (P < 0.01) between fear of reoperation and QOL on both the mental and physical scales. There was no difference between the 2 cohorts with respect to fear of valve failure. Patients with mechanical valves were more concerned about frequency of medical visits and blood tests (P < 0.01) as well as the possibility of anticoagulant-related bleeding events (P < 0.01). QOL was equivalent between the 2 groups and to the general population for the same age group. Ninety-seven percent of the patients indicated they would make the same surgical decision again with regard to valve replacement; there was no difference between the 2 valve groups on this question.
Patient-perceived QOL is similar between patients with aortic mechanical and biological valve replacement in the studied age group and comparable to the general population of similar age. Although certain valve-specific differences exist between the 2 prosthetic types, these differences do not appear to affect overall QOL as described by these patients.
本研究的目的有三个：比较在单纯主动脉瓣置换术中接受生物瓣膜和机械瓣膜的年龄及性别匹配患者的生活质量（QOL）；比较主动脉瓣置换患者与普通人群的生活质量；比较生物瓣膜和机械瓣膜患者对某些瓣膜特定问题的回答，并将这些回答与总体生活质量相关联。
从1986年至1996年期间接受单纯主动脉瓣置换术的420名患者（年龄范围51至65岁）中抽取200名患者，评估其自我感知的生活质量。抽取的患者中，100名植入了机械瓣膜，另外100名植入了猪生物瓣膜。使用三种调查工具来检查自我感知的生活质量：SF - 12表格、一份包含7个瓣膜特定问题的表格以及拉米笑脸表格。问卷回复率为89.5%（179名患者）。机械瓣膜患者更容易受到瓣膜声音的困扰（P < 0.01），并且仅在心理量表上，瓣膜声音与生活质量呈负相关（P < 0.01）。生物瓣膜患者更担心再次手术的必要性（P < 0.01），但担心程度与生活质量之间无相关性。机械瓣膜组在心理和生理量表上，对再次手术的恐惧与生活质量均呈负相关（P < 0.01）。两组患者在对瓣膜故障的恐惧方面无差异。机械瓣膜患者更担心就诊频率和血液检查（P < 0.01）以及抗凝相关出血事件的可能性（P < 0.01）。两组患者的生活质量相当，且与同年龄组的普通人群相当。97%的患者表示就瓣膜置换而言，他们会再次做出相同的手术决定；在这个问题上，两组瓣膜患者之间没有差异。
在研究的年龄组中，接受主动脉机械瓣膜和生物瓣膜置换的患者自我感知的生活质量相似，且与相似年龄的普通人群相当。尽管两种假体类型之间存在某些瓣膜特定的差异，但这些差异似乎并未影响这些患者所描述的总体生活质量。
