年龄对风湿性主动脉瓣置换术后患者生活质量影响的前瞻性研究

Influence of age on quality of life of patients with rheumatic aortic valve disease after aortic valve replacement: a prospective study

目的研究年龄对风湿性主动脉瓣置换术后患者生活质量的影响。方法采用前瞻性队列研究方法,将符合入选条件的2010年3月至2010年12月期间在长海医院接受主动脉瓣置换术的风湿性心脏病患者根据年龄分为3组:A组,<45岁;B组,≥45岁且<65岁;C组,≥65岁,每组14例。使用SF-36量表评估患者术前和术后不同时间(3、6、12个月)的生活质量。采用配对非参数Wilcoxon秩和检验分析3组术后与术前生活质量评分的变化;采用重复测量方法分析年龄对患者术后生活质量评分的影响。结果 (1)与术前相比,A、C两组术后3个月生理职能(RP)、总体健康(GH)、活力(VT)和精神健康(MH)等4个维度,以及术后6、12个月SF-36量表8个维度评分差异均有统计学意义(P<0.05);B组术后3个月RP、GH、VT和社会职能(SF)等4个维度评分差异均有统计学意义(P<0.05),术后6个月除MH外,余7个维度差异均有统计学意义(P<0.05),术后12个月,8个维度评分差异均有统计学意义(P<0.05)。(2)各组之间比较,除A组GH评分趋势显著好于B、C两组(P=0.000)外,余7个维度评分差异均无统计学意义。结论风湿性主动脉瓣置换术后患者生活质量有明显改善;年龄不是影响患者术后生活质量的危险因素,但对年轻患者及时行手术治疗更有利于其GH的恢复。

Objective To study the influence of age on quality of life（QOL） of patients with rheumatic valve disease after aortic valve replacement.Methods A total of 42 patients with rheumatic aortic valve disease who received aortic valve replacement in Changhai Hospital during March 2010 to Dec 2010 were prospectively studied.The patients were divided into 3 groups according their ages：（1） group A,45 years,（2） group B,≥45 years and 65 years,and（3） group C,≥65 years.QOL of patients was measured at baseline and at 3 months,6 months and 12 months after operation using Short Form 36-Item（SF-36） Health Survey.Wilcoxon matched pairs rank test was used to analyze the changes of patients＇ QOL after surgery,and repeated measurement was used to analyze the influence of age on QOL of rheumatic patients.Results（1） Four of the eight domains of the SF-36,including role-physical（RP）,general health（GH）,vitality（VT）,and mental health（MH） were significantly improved in group A and C at 3 months after operation（P0.05）,and all the eight domains were significantly improved at 6 and 12 months after operation（P0.05）.For group B,four domains,including RP,GH,VT and social function（SF）,were significantly improved at 3 months after operation（P0.05）;all the domains but MH were significantly improved at 6 months after operation（P0.05）,and all the 8 domains were significantly improved at 12 months after surgery（P0.05）.（2） All the domains but GH had no significant difference between the 3 groups.The GH score in group A were significantly improved than that in group B and C（P=0.000）.Conclusion The QOL of patients with rheumatic heart valve disease is improved after operation.Age is not a risk factor of QOL in patients with rheumatic heart valve disease after aortic valve replacement;younger patients seem to benefit more from the surgery for the GH score.