非体外循环下冠状动脉搭桥术后生存质量的调查

福建医科大学硕士学位论文非体外循环下冠状动脉搭桥术后生存质量的调查姓名：何佳俊申请学位级别：硕士专业：外科学（胸心外）指导教师：陈良万2011-043::::200910201012108SF-368SF-36()SF-368(P0.05)(P0.05)4AbstractObject:Toinvestigateandevaluatethelifequalityofpatientsfollowingoff-pumpcoronaryarterybypassgraftingbytheSF-36QualityofLifeQuestionnaire.Methods:Asampleof108patientswhohadunderwentoff-pumpcoronaryarterybypassgrafting(off-pumpCABG)duringSeptember2009toDecember2010hadcompletedtheSF-36QualityofLifeQuestionnairepersonallyorthroughtelephoneinterviewsurveys.TheSF-36QualityofLifeQuestionnairecompriseseightsubscalesthatrepresentdifferentaspectsofwell-being,physicalfunctioning(PF),bodilypain(BP),rolelimitationscausedbyphysicalhealthproblems(RP),rolelimitationscausedbypersonaloremotionalhealthproblems(RE),generalmentalhealth(MH),socialfunctioning(SF),vitality(VT)andgeneralhealthperception(GH).Inthisstudy,thescoresofthepatientswerecomparedtothescoresofnormalhealthysubjectsfromSichuanprovince(controlgroup).Result:ThestudygroupshowedobviouslowerscoresinthePFBP,SF,RPsubscales.Statisticallysignificantdifferences(P0.05)werefoundinthesesubscalesbetweenthestudygroupandthecontrolgroup.TherewerenosignificantdifferencesbetweentwogroupsinREMHVTGHsubscales.Conclusion:Thoughpatientsfollowingoff-pumpCABGtendtohaveapoorlifequalitycomparedtogeneralpopulation,thesurgeryhasshownnosignificantimpactonpatients’emotionandmentalhealth.Keywords:off-pumpcoronaryarterybypassgraft(off-pumpCABG)qualityoflife(QOL)Questionnairesurveyoutcomeevaluation1__________________________________________________________________________________________________________________________5coronaryatheroscleroticheartdiseasecoronaryarteryheartdisease,CHD302140-60()6()coronaryarterybypassgraftCABG2—/—-/-(OPCABG)—/—/-ICU,CABG7108,,,,----(CABG)1,QualityofLifeQOL8200910201012108SF-368SF-36()SF-36SPSS17.0SF-368(P0.05)(P0.05)CABG912009102010121082111,3,,108,97.3%,108,96,12,42~81(63.188.71):30;19,II13,III87,IV8226,369,41321.1(SF-36)SF368210368(1)PF(2)(SF)(3)(RP)(4)(BP)(5)(MH)(6)(RE)(7)(VT)(8)(GH)2362SF-36SF-36010010PF3a+3b+3c+3d+3e+3f+3g+3h+3i+3j103020RP3a+3b+3c+3d484BP7+82119GH1+11a+11b+11c+11d22520VT9a+9e+9g+9i42420SF6+10208RE5a+5b+5c363MH9b+9c+9d+9f+9h53025/1001SF-36(xs)SF-3682.828.8768.4210.4879.8612.1874.6918.7271.228.6468.2910.9085.568.2173.8414.6685.6118.3770.2917.0786.8517.2876.4538.4772.5616.8169.5521.3290.6215.4079.5134.70t-3.265-1.850-5.961-0.975-1.717-1.204-6.409-4.019P0.0010.0670.0000.3320.0890.2310.0000.000111.2SF362001SF36()()31.3SPSS(17.0)(xs)tP0.05121.82.828.8768.4210.4879.8612.1874.6918.7271.228.6468.2910.9085.568.2173.8414.6685.6118.3770.2917.0786.8517.2876.4538.4772.5616.8169.5521.3290.6215.4079.5134.702.SF-368(P0.05)(P0.05)3.:85.2%92CABG13CABG4CABGCABGSF-36(theMOSitemshortfromhealthsurvey,SF-36)1988Stewartse(medicaloutcomesstudyshortfrom,MOSSF)1991SF-36SF-368,SF-36,14SF-368(P0.05)(P0.05)CABG,,CABGCABGCABGQOLCABG,,,,(),,,,),15,5,CABG,CABG6Lindsay7SF-36214CABG216,,CABG11232,,17108SF-36181.,,,..2009,4(3):32-34.2.SF-3620011816-8.3.,SF-36200132(1)43—474..2002176411-13.5.JanneJ.Jokinen,M.D.,Ph.D.,MikkoJ.Hippelainen,ect.Health-RelatedQualityofLifeAfterCoronaryArteryBypassGrafting:AReviewofRandomizedControlledTrialsJCARDSURG2010;25:309-317.6.2007234228-30.7.,.1999,16(3):119coronaryatheroscleroticheartdiseasecoronaryarteryheartdisease,CHD1302140-601.1.151.1.1STT1.1.2201.1.31.1.41.1.51.21.2.11.(LDL-C)2.(CK-MBLDH/LDH)3.1.2.21.()2.DCG24h3.214.“”ST5.6.X()-()7.()8.CTCTMRI(%)CABG9.10.()2.222.12.2/2.32.43.()23.13.1.1()()β()23L()()3.1.21977percutaneouscoronaryinterventionPCI()(percutaneoustransluminalcoronaryangioplastyPTCA)()()()()()3.2()4.4.1coronaryarterybypassgraftCABGCABG24KolesonFavaloroCABG10CABG2—/—-/-(OPCABG)—/—/-ICU,CABG4.225,,/Burch197056-4.32678β950705.275.165%90%10.4%3%5.219705%12%1%105.380%95%75%Adam61882%182476%244369%115.431075%50%E3028291.MaryCMancin2007,6(3):3-5.2.Van'tHofAW,TenBergJ,HeestermansT,etal.OngoingTirofibanInMyocardialinfarctionEvaluation(On-TIME)2studygroup.PrehospitalinitiationoftirofibaninpatientswithST-elevationmyocardialinfarctionundergoingprimaryangioplasty(On-TIME2):amulticentre,doubleblind,randomized,controlledtrial,[J].Lancet,2008,372(9638):537-546.3.ShepherdJ,KasteleinJJ,BittnerV,etal.TNT(TreatingtoNewTargets)Investigators.Intensivelipidloweringwithatorvastatininpatientswithcoronaryheartdiseaseandchronickidneydisease:theTNT(TreatingtoNewTargets)study[J].JAmCollCardiol,2008,51(15):1448-1454.4.2002,7(4)112-16.5.SeungKB,ParkDW,KimYH,etal.Stentsversuscoronary-arterybypassgraftingforleftmaincoronaryarterydisease[J].NEnglJMed,2008,358:1781-1792.6.YangT,KimD,ParkS,etal.Clinicalcharacteristicsofstentfractureaftersirolimus-elutingstentimplantation[J].IntJCardiol,2008,131(2):212-216.7.2008,26(3):143-145.8.,,,.[J].,2005,21:366-367.9.ChuMW,WilsonSR,NovickRJ,eta1.Doesclopidogrelincreasebloodlossfolowingcoronaryarterybypasssurgery[J]AnnThoracSurg,2004,78:1536-1541.10.HiraiSSystemicinflammatoryresponsesyndromeaftercardiacsurgeryundercardiopulmonarybypass2009,2313-2315.11.FransVandeWerf,JeroenBax,Amadeo