二尖瓣置换术后生存质量变化随访研究

Follow-up study on quality of life after mitral valve replacement

目的 评估经二尖瓣置换术（MVR）或二尖瓣修复（MVP）6个月后患者是否有具有生活质量（QOL）的实际改善.方法 随访1993年3月至2013年11月120例[51名男性,平均年龄（42.3±11.2）岁;69名女性,平均年龄（43.3±13.9）岁]接受二尖瓣置换术（MVR、n=82）或二尖瓣修复术（MVP、n=38）病人的QOL状况,使用生活质量评定量表（SF-36）分别于手术前和术后6个月以上进行问卷调查测定QOL指数,采用Wilcoxon配对符号秩和检验统计分析.结果 120例二尖瓣手术后随访患者的QOL指数平均得分有所改善,各维度QOL指数分值为：①生理功能：术后（58±29）vs.术前（41±26）,P=0.000;②生理职能：术后（52±44）vs.术前（25±27）,P=0.000;③社交功能：术后（76±36）vs.术前（55±38）,P=0.000;④情感职能：术后（70±45）vs.术前（40±40）,P=0.000;⑤生命活力：术后（57±33）vs.术前（40±30）,P=0.000;⑥精神健康：术后（70±24）vs.术前（61±24）,P=0.004;⑦总体健康：术后（65±29）vs.术前（52±26）,P=0.0003;⑧身体痛苦：术后（70±30）vs.术前（68±33）,P=0.624.MVP患者QOL指数与MVR患者健康维度QOL指数改善相同.射血分数≥50％患者和左心室功能受损患者的QOL指数在7个维度上显著改善.左室舒张末期内径≥50 mm患者在术后3个月的随访中QOL指数在5个维度上显著改善.结论 本次开展的二尖瓣疾病患者手术后6个月随访研究表明,经二尖瓣修复术的患者QOL提高明显,左心室功能受损和左室舒张末期尺寸≥50 mm的患者术后至少在5个维度上QOL明显改善.

Objective To assess whether there is an actual improvement in quality of life （QOL） of patients 6 months following primary mitral valve plasty （MVP） or mitral valve replacement （MVR）.Methods Following up study of 120 consecutive patients [51 males,the average age of （42.3 ± 11.2） years-old; 69 females,the average age of （43.3 ± 13.9） years-old] who underwent primary isolated mitral valve plasty （MVP,n =38） or mitral valve replacement （MVR,n =82） from March 1993 to November 2013.QOL parameters using the validated short form 36 （SF-36） questionnaire were determined before and 6 months after surgery and analyzed with Wilcoxon matched pairs rank test.Results Mean QOL scores for all patients following mitral valve surgery showed clinical and statistically significant improvement in seven of eight QOL parameters,namely （Ⅰ） physical function [post （58 ± 29） vs.pre （41 ± 26）,P--0.000]; （]]） role limitation due to physical function [（52 ± 44） vs.（25 ± 27）,P =0.000]; （Ⅲ） social function [（76 ± 36） vs.（55 ± 38）,P =0.000]; （Ⅳ） role limitation due to emotional problems [（70 ± 45） vs.（40 ± 40）,P =0.000]; （Ⅴ） energy [（57 ± 33） vs.（40 ± 30）,P =0.000]; （Ⅵ） mental health [（70 ± 24） vs.（61 ± 24）,P =0.004]; （Ⅶ） general health perception [（65 ± 29） vs.（52 ± 26）,P =0.0003]; but not pain [（70 ± 30） vs.（68 ± 33）,P =0.624].Following MVP there was significant improvement in seven of eight QOL parameters and following MVR there was significant improvement in six of eight QOL parameters.Whilst patients with ejection fraction ≥ 50％ showed significant improvement in seven of eight QOL parameters,there was significant improvement in any QOL parameters in patients with impaired left ventricular （LV） function.Similarly,patients with mitral regurgitation with end-diastolic dimensions ≥ 50 mm showed significant improvement in any QOL parameters at 6 months follow-up.Conclusions Our study suggested that following mitral valve surgery there was significant improvement in QOL of patients especially in those patients requiring mitral valve repair.However,patients with impaired LV function and those with MR with end-diastolic dimensions ≥ 50 mm were likely to demonstrate a significant improvement in QOL at 6 months follow-up.