冠狀動脈疾病病患施行冠狀動脈成形術術後生活品質之探討

冠狀動脈疾病(coronary artery disease，簡稱CAD)最為常見的心血管疾病。介入性治療 (Percutanious Coronary Intervention)是CA主要的處置之一。現今臨床上多強調對病患治療後存活及血管重建結果，後續病患回家生活品質追蹤仍是鮮少有相關探討。故本研究探討冠心病患者接受冠狀動脈成形術後，患有冠狀動脈疾病之病患，未執行冠狀動脈成形術前，及術後生活品質的變化。方法：從99年10月至100年4月期間在南部某醫學中心患有冠心病64位急性心肌梗塞，ST段沒有上升及有ST段上升之個案 (21.9%及78.1%)分別以中譯版國際通用SF-36生活品質量表及疾病別冠心病專用西雅圖心絞痛問卷(SAQ)量表為測量工具，問卷收集共有三次，首先在心導管術術前及術後，病患第一個月及第三個月返家以電話追蹤方式，以重複測量GEE Model 、Independent samples T-test、Effect Size探討SAQ與SF-36生活品質及其相關危險因子在不同三個時間作比較。結果：研究樣本以男性52位(81.3%)居多，平均年齡59±13.2歲，疾病心肌梗塞疾病嚴重度以Killip I居多，有38人；術後病患在第一個月SAQ 5個健康相關面向，均達顯著改善(P＜0.001)，其中，第3個月心絞痛穩定度(P＜0.310)及治療滿意(P＜0.518)未均達顯著差異；在第一個月SF-36生活品質8個健康相關面向，均達顯著改善(P＜0.001)，第3個月，在社會功能(P＜0.086)及情緒角色受限(P＜0.243)，未達顯著差異。術後的SF36在所有面向身體和心理健康量（0.48〜2.56）及SAQ在所有面向治療滿意度及疾病感受度（0.34~1.91）均有改善趨勢。討論：研究結果顯示，冠狀動脈成形術後介入措施確實可以改善病患的生活品質。護理人員繼續給予病患適當衛教及提供護理措施，使得病患術後生活品質之提升。

關鍵字

PCI ； Health releted quality ； SF36 ； SAQ ；冠狀動脈疾成病形術； CAD

並列摘要

Coronary artery disease (CAD) is a prevalent cardiovascular problem. To treatment his patient population, percutaneous coronary intervention (PCI) is a principal method. To date survival and revascularization are still emphasized outcome indicators. However, quality of life (QOL) after PCI is yet little in known. The purpose of this study was to assess whether change in quality of life for patients with CAD after undergoing PCI. Methods: Patients were recruite from a southern medical center from Octorber 2010 to April 2011. Sixty-four patients who had angina with/without ST elevation Myocardial Infraction (78.1% vs. 21.9%) and admitted for an emergency PCI were recruited in this study. SF-36 and SAQ was used to measure QOL for these sample patients. This tool has been popularly using to evaluate QOL among many patients population. After informed consent signed, participants were asked to fill out the SAQ and SF-36 for 3 times. Data regarding first time of QOL for the participants were collected before them undergoing their PCI. Then, their QOL were followed up twice by telephone and when patients came back to their clinic for checking in one and three months later, respectively. By using repeated measures of GEE, independent samples t-test, effect size, differences in quality of life and relative risk factors among those 3 phases were compared. Results: The majority of participants were men (n=52, 81.3%), aged 59±13.2. There were 38 (59.3%) patients in less severity (Killip I) of myocardial infraction. Three of 5 in SAQ domains in level of QOL were increased significantly( P＜0.001) over time from before PCI to 1 month after PCI, and from 1 month to 3 month after PCI . Six of 8 of SF36 domains in level of QOL were increased significantly( P＜0.001) over time from before PCI to 1 month after PCI, and from 1 month to 3 month after PCI. After PCI, the SF36 effect sizes (0.48 to 2.56) were all improved in all domains. SAQ effect sizes were all improved in all domains (0.34 to 1.91). Discussion: The results of this study showed that patients with CAD perceived improving their QOL after PCI procedure. The perception of QOL seems continuously getting better after undergoing their PCI. Proper patients education and nursing interventions should be introduced for those patient population immediately post-PCI to promote patients’ QOL.