微创冠状动脉旁路移植术与常规不停跳冠状动脉旁路移植术后患者生活质量比较的倾向性评分匹配研究

Quality of life in patients after minimally invasive coronary artery bypass grafting surgery versus off-pump coronary artery bypass grafting surgery:A propensity score matching study

目的分析微创冠状动脉旁路移植术(minimally invasive coronary artery bypass grafting,MICABG)与常规正中开胸心脏不停跳冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)患者术后的生活质量。方法纳入2015年11月—2018年1月在北京大学第三医院经左胸前外侧小切口完成MICABG手术94例患者为MICABG组,同期接受常规正中开胸OPCABG手术患者441例为OPCABG组。按1∶1比例进行倾向性评分匹配。通过SF-36生活质量量表测评比较两组患者术后1个月、6个月及12个月的生活质量。结果最终两组各匹配82例患者,MICABG组男66例、女16例,平均年龄(62.6±8.2)岁,OPCABG组男67例、女15例,平均年龄(63.2±13.2)岁。术后1个月MICABG组躯体健康总评(physical component summary,PCS)及精神健康总评(mental component summary,MCS)均高于OPCABG组[(50.3±10.6)分vs.(46.1±10.3)分,P=0.011;(59.5±9.3)分vs.(54.2±11.0)分,P=0.002],MICABG组在一般健康状况、生理机能、生理职能、社会功能、情感职能5个维度评分高于OPCABG组,躯体疼痛维度评分低于OPCABG组,差异均有统计学意义(P均<0.05)。术后6个月两组患者的PCS及MCS差异均无统计学意义[(80.0±13.1)分vs.(77.8±12.4)分,P=0.271;(81.6±13.5)分vs.(80.4±11.2)分,P=0.537],但MICABG组生理机能及社会功能2个维度评分仍高于OPCABG组,差异有统计学意义(P<0.05)。术后12个月两组各维度评分差异均无统计学意义(P>0.05)。结论MICABG术后6个月内生活质量改善优于OPCABG,术后12个月时与OPCABG相似,提示MICABG在改善术后早期生活质量方面有一定优势,远期生活质量与OPCABG相当。

Objective To compare and analyze the postoperative quality of life in patients after minimally invasive coronary artery bypass grafting(MICABG)and conventional median thoracotomy off-pump coronary artery bypass grafting surgery(OPCABG).Methods From November 2015 to January 2018,94 patients who underwent MICABG in the Peking University Third Hospital were included in the MICABG group.During the same period 441 patients who received OPCABG were included in the OPCABG group.The patients were matched by using propensity score matching method with a ratio of 1∶1.The quality of life was compared between two groups at 1 month,6 months and 12 months after the surgery using SF-36 scale.Results A total of 82 patients were matched for each group.In the MICABG group,there were 66 males and 16 females with a mean age of 62.6±8.2 years.In the OPCABG group,there were 67 males and 15 females with a mean age of 63.2±13.2 years.One month after the operation,the physical health assessment(PCS)and mental health assessment(MCS)of the MICABG group were higher than those of the OPCABG group(50.3±10.6 points vs.46.1±10.3 points,P=0.011;59.5±9.3 points vs.54.2±11.0 points,P=0.002).Scores of these following five dimensions:general health,physical functioning(PF),role-physical,social functioning(SF),role-emotion in the MICABG group were higher than those in the OPCABG group,while the score of body pain was inferior to that in the OPCABG group,and the differences were statistically significant(P<0.05).Six months after the surgery,the PCS and MCS of the two groups were not statistically different(80.0±13.1 points vs.77.8±12.4 points,P=0.271;81.6±13.5 points vs.80.4±11.2 points,P=0.537).However,the scores of PF and SF in the MICABG group were still higher than those in the OPCABG group(P<0.05).Twelve months after the surgery,there was no statistical difference in the score of each dimension between the two groups(P>0.05).Conclusion The improvement of quality of life within 6 months after MICABG is better than that of OPCABG,and it is similar between the two groups at 12 months after the surgery,indicating that MICABG has a certain effect of improving the short-term quality of life after the surgery,and the long-term quality of life is comparable to conventional surgery.