风湿性心脏病瓣膜置换术后早期生存质量

Short-term life quality after heart valve replacement in patients with rheumatic heart disease

目的探讨风湿性心脏病瓣膜置换术后患者早期生存质量及其影响因素。方法对2010年10月至2011年5月间实施心脏瓣膜置换术的135例患者,使用SF-36健康量表进行术前、术后生存质量的评估,根据SF-36得分高低,以中位数为界,将全组病例划分为高分组69例及低分组66例,使用Logistic回归分析影响患者术后评分高低的因素。结果 (1)所有患者术后生存质量评分均明显高于术前(P<0.05,P<0.01);(2)尽管女性患者术前所有维度评分均低于男性患者(P<0.05,P<0.01),但术后6个月仅在躯体疼痛及心理健康2个维度与男性患者相比差异具有统计学意义(P均<0.01);(3)Logistic回归分析结果显示,术后住院时间及总住院时间分别影响患者术后躯体健康评分(PCS)及心理健康评分(MCS),呈负相关(OR=0.804,P=0.041;OR=0.882,P=0.023),而文化程度则与术后PCS及MCS评分呈正相关(OR=11.624,P=0.008;OR=8.700,P=0.011)。结论风湿性心脏瓣膜病患者行心脏瓣膜置换术可明显提高患者生存质量,但生存质量改善程度受文化程度高低、住院时间长短的影响,因此,加强对患者围术期健康教育、术后早期进行康复锻炼、缩短住院时间,有助于进一步提高患者术后生存质量。

Objective To evaluate the quality of life（QOL） after heart valve replacement in patients with rheumatic heart disease and analyze its influencing factors. Methods A total of 135 patients with rheumatic valve disease received valve replacement in our hospital between October 2010 and May 2011 were studied. The QOL was measured at baseline and 6 months after surgery using the Short Form 36-Item （SF-36） Health Survey. According to the SF-36 scores, all of the patients were divided into 2 groups： the high score group and the low score group. Influencing factors were analyzed using the Logistic regression model. Results （ 1 ） Scores of all the eight domains of SF-36 were significantly improved in all the pa tients at 6 months after the surgery （P 〈0.05 or P 〈0. 01 ）. （2） All the domains but physical pain and mental health had no significant difference between men and women after surgery. （3） Higher educational level and shorter lengths of hospital stay were related to the better score. Conclusions The QOL of patients with rheumatic heart valve disease is improved after valve replacement, and it is influenced by the educational attainment and the lengths of hospital stay. Strengthening healthy education of peri-operational period, conducting rehabilitation exercise on early stage and shortening time of hospital stay are helpful to improve the postoperative QOL further.