老年冠心病患者冠脉旁路移植及冠脉支架术后生活质量比较

The evaluation of the midterm functional quality of life in senile patients after coronary artery bypass graft(CABG) and percutaneous coronary intervention(PCI)

目的冠状动脉旁路移植术(CABG)和冠脉支架植入术(PCI)两种术式对改善高龄患者生活质量、减少心血管意外事件发生及延长寿命均有显著的效果。本研究对PCI和CABG术后老年冠心病患者进行术后生活质量长期随访,旨在探讨两种治疗方法对冠脉血运重建的远期效果,并以此为基础对比患者心功能的改善情况,进而评估CABG和PCI在术后远期生活质量方面给老年患者带来的效果。方法选自2003年2月1日-2012年8月31日入某院心胸外科接受CABG的70岁以上老年冠心病患者117例(CABG组)及同期医院心内科行PCI的老年患者115例(PCI组)。经电话随访收集患者术后相关指标,收集两组患者治疗后主要心血管不良事件的再发情况及血运重建术后患者的生活质量,通过KPS及Barthel评分对比两组患者在生活自理、自主锻炼等相关指标,比较两组患者心功能的恢复情况及远期生活质量。结果 CABG和PCI患者的Barthel评分结果分别为(75.6±12.2)及(65.5±10.5)。术后2年再入院情况对比CABG组为27.4%,PCI组为61.7%(P<0.05)。CABG后患者中有57.7%在术后2年以上时间内完全自主生活,对比PCI组为23.9%(P<0.05),CABG组患者79.4%能进行日常锻炼,PCI组仅有40.2%能进行日常锻炼(P<0.05)。结论 CABG与PCI治疗相比较,对于老年冠心病患者改善心功能具有优势,再入院明显减少,日常锻炼更加普遍,远期生活质量得到更好的改善。

Objective Coronary artery bypass grafting （CABG） and percutaneous coronary intervention （PCI） improve the quality of life of patients and reduce the cardiovascular accidents. The aim of this study is to evaluate the improvement of ventricular dysfunction and then to estimate the midterm functional quality of life in senile patients after CABG and PCI. Methods From February 1,2003 to August 31, 2012, 117 consecutive patients above age 70 underwent CABG and 115 consecutive patients underwent PCI. Using the Karnofsky Performance Score and Barthel Index, patients were evaluated for functional autonomy, living disposition, and leisure activity by a single telephone interview. Results The average Barthel score of CABG group was （75.6 ± 12.2） and PCI group was （65.5 ± 10.5）. The readmission rate at two years in CABG Group was 27.4%, while the PCI group was 61.7% （ P 〈 0.05 ）. Among survivors in CABG group, 57.7% were autonomous, and 79.4% have some exercise. For the PCI group, 23.9% were autono- mous and only 40. 2% do have exercise （ P 〈 0. 05 ）. Conclusion For the senile patients （ ≥70 years） coronary artery bypass graft provide them with obvious promotion of ventricular dysfunction and an excellent quality of life in futurity.