高齡冠狀動脈繞道手術患者健康相關生活品質與身體功能之相關性探討

摘要研究背景：冠狀動脈疾病是高齡族群常見而且嚴重的血管性疾病，因醫療技術進步，隨著冠狀動脈疾病存活率的增加，術後患者健康生活品質也越來越受到重視。但現有術後高齡患者健康生活品質相關文獻不多且僅以單一種一般性健康生活品質問卷(Generic Health-related Quality of Life Questionnaires)評估，未能完整反映患者健康生活品質。適當且完善的復健運動計畫可以改善患者術後生活品質，若能了解健康相關生活品質與各面向身體功能之相關性，將有助於復健運動計畫之擬定。目的：利用三種不同的健康生活品質問卷，The Medical Outcomes Study 36-item Short-Form Health Survey (簡稱SF-36)、台灣簡明版世界衛生組織生活品質問卷[World Health Organization Quality of Life (WHOQOL)-BREF(簡稱WHOQOL- BREF)] 、MacNew心臟疾病健康相關生活品質問卷(MacNew Heart Disease Health-related Quality of Life，簡稱MacNew)，來多方位評估高齡冠狀動脈繞道手術患者的生活品質，並探討健康相關生活品質與身體功能(有氧能力、肺功能、肌力)之相關性。方法：研究採用橫斷性研究設計，收取30位接受過冠狀動脈繞道手術的高齡患者。每位受試者隨機填寫SF-36、WHOQOL- BREF及MacNew問卷，並接受症狀限制運動測試、肺功能測試及肌力測試。統計分析：以斯皮爾曼相關統計分析(Spearman correlation analysis)進行健康相關生活品質問卷各面向與身體功能各參數之相關分析。以逐步迴歸分析法(Stepwise regression analysis)來評估身體功能對健康相關生活品質之解釋力及預測力。研究結果：高齡冠狀動脈患者在健康相關生活品質的各面向表現皆較差，有氧能力(V̇O2peak)僅與MacNew生理面向有相關性(rho=0.395，p=0.031)，肺功能與問卷各面向無相關，而肌力與健康相關生活品質問卷身體生理面向、心理、社會等面向皆呈現顯著正相關(rho=0.373-0.680，p=0.042-0.001)。逐步迴歸分析結果發現，肌力是影響高齡冠狀動脈繞道手術生活品質的主要因子。結論與建議：高齡冠狀動脈繞道手術患者在各面向，例如生理、心理、社會等皆表現較差，而肌力是影響其身體功能相關的生活品質之重要因子。建議未來對於高齡患者所擬定之第二期心臟復健運動訓練，除了有氧能力的加強外，肌力訓練應是不可或缺的訓練內容，以期有效改善患者生活品質表現。

關鍵字

冠狀動脈繞道手術；健康相關生活品質；身體功能

並列摘要

Abstract Background The coronary artery disease (CAD) is a serious vascular disease commonly seen in the older. Due to the medical advances, the survival rate of the CAD patients after coronary artery bypass grafting (CABG) is growing. Consequently, the quality of life (QOL) among these patients is more and more emphasized. The literature on the QOL in the older patient with CABG was few, mostly done with only one generic health-related QOL questionnaire and thus has not been fully explored. An appropriate rehabilitation program can improve the QOL of the patients with CABG. Understanding the relationship between the quality of life and the physical function will help to set up an effective rehabilitation program. Purpose This study was to comprehensively investigate the health-related quality of life with three different questionnaires, the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), World Health Organization Quality of Life (WHOQOL-BREF), and MacNew Heart Disease health-related quality of life(MacNew) and to explore the correlation between the QOL and physical functions (aerobic, pulmonary and muscular aspects) in the older patient after CABG. Method A cross-sectional study design was used. Thirty older patients who underwent CABG were recruited. Each patient completed the above-mentioned questionnaires and received a symptom-limited exercise test, a pulmonary function test, and muscle strength tests. The spearman correlation analysis was used to evaluate the correlation between the physical functions and each domain in the health-related QOL questionnaires. The stepwise regression analysis was used to explore the explanatory power and predictability of the physical function for QOL. . Results The older patients underwent CABG showed poor performances in all aspects of the three questionnaires. Only the physical domain of MacNew showed a significant correlation with peak oxgen consumption (rho=0.395，p= 0.031). No significant correlation was noted between the pulmonary function and any aspect of the three questionnaires. We found low to moderate positive correlations between muscle strength and the physical/psychological/social aspects in the three questionnaires (rho=0.373-0.68，p=0.042-0.001). Muscle strength is the main factor that influenced the QOL of the older underwent CABG. Conclusion and suggestions Older patients underwent CABG showed poor performances in all domains of the three questionnaires. Muscle strength is the most important factor that influences the QOL. In order to improve the QOL, we suggest that resistance training should be incorporated into the phase II cardiopulmonary rehabilitation program for the older patient underwent CABG, in addition to aerobic capacity training.