急性冠状动脉综合征患者生活质量及其影响因素

摘要

Objective To identify the changes in Health Related Quality of Life(HRQL) 6 months after discharge from hospital in patients who have had an acute coronary episode,and to determine the clinical and sociodemographic variables that explain those changes.Methods HRQL was assessed in patients while they were admitted to the hospital and at 6 months after discharge,using the Seattle angina questionnaire.To identify the variables associated with the change,Logistic regression models were constructed for five summary dimensions of the Seattle angina questionnaire taking the change in the score of the dimension as dependent variable.Results The Seattle angina questionnaire scores improved at the 6-month visit.The variables age,gender,marital status,education level,hypertension and previous history of coronary heart disease explain the changes of life quality.Logistic regression reveal that treatment (OR:0.009,95％ CI:0.001-0.064,P ＜ 0.01) and history of myocardial infarction (OR:3.063,95 ％ CI:1.395-6.726,P ＜ 0.05) associated with greater improvement of life quality.Conclusions Sociodemographic characteristics should be taken into account when comparing and interpreting changes in quality life scores.Treatment and history of myocardial infarction are associated with greater improvement of life quality.%目的 调查急性冠状动脉综合征(ACS)患者生活质量变化及其影响因素分析,为提高ACS患者生活质量提供依据.方法 选取安贞医院心内科2010年6-10月完成6个月随访的ACS患者389例,使用西雅图心绞痛量表对患者就诊时和治疗后6个月的生活质量进行评估,并分析影响因素与生活质量变化的关系.结果 治疗6个月后,ACS患者躯体活动受限程度、心绞痛稳定状态、心绞痛发作频率情况、治疗满意程度、疾病认识程度均较基线水平明显改善,治疗前后差异均有统计学意义[(80±16)分比(69±17)分,(64±17)分比(40 ±22)分,(79±14)分比(58±18)分,(76±13)分比(72±17)分,(43±17)分比(40±23)分,P＜0.01或P＜0.05].通过广义线性模型分析出影响生活质量的主要因素有年龄(P=0.001)、性别(P=0.048)、婚姻(P =0.001)、高血压(P =0.012)、受教育程度(P =0.037)、既往冠心病史(P=0.019).Logistic回归分析结果示治疗方式为ACS患者生活质量改善的保护因素[比值比(OR) =0.009,95％置信区间(CI):0.001 ～0.064,P＜0.01],既往心绞痛史为ACS患者生活质量改善的危险因素(OR =3.063,95％ CI:1.395 ～6.726,P＜0.05).结论 年龄、性别、婚姻、高血压、受教育程度、既往心绞痛史、既往冠状动脉介入史均能够影响ACS患者的生活质量.治疗方式和既往心绞痛史是ACS患者生活质量改善的独立影响因素.