台灣老人冠狀動脈繞道手術後生活品質與身體功能關聯性之研究

Association between Physical Function and Quality of Life among Older Adults after Coronary Artery Bypass Graft Surgery in Taiwan

目的：利用三種不同的健康生活品質問卷，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之相關性。方法：採用橫斷性研究設計，收錄近一個月因為接受過冠狀動脈繞道手術的60歲以上成人患者。每位受試者皆完成健康調查簡表(SF-36)、台灣簡明版世界衛生組織生活品質問卷(WHOQOL- BREF)、MacNew心臟疾病健康相關生活品質問卷(MacNew)之填寫，並接受症狀限制運動測試、肺功能測試、六分鐘行走測試及肌力測試。以斯皮爾曼相關統計分析進行相關性之分析、逐步迴歸分析法來評估身體功能對健康相關生活品質之解釋力。結果：最終收錄30位患者，其在三份量表的各面向表現皆較差，尖峰耗氧能力僅與MacNew生理面向有相關性(rho=0.395，p=0.031)，肺功能與三份問卷各面相皆無相關，而肌力與三份量表身體生理面向、心理、社會等面向皆呈現顯著正相關(rho=0.373-0.680，p=0.001-0.042)。逐步迴歸分析發現肌力是影響術後健康生活品質當中身體面向的主要因子(p=0.001-0.034)。結論：60歲以上冠狀動脈繞道手術患者在健康相關生活品質量表各面向皆表現較差，身體功能當中肌力是影響其健康相關生活品質之身體面向(physical domain)的重要因子。

Objectives. We aimed to evaluate the relationship between the objective physical functioning in adults after coronary artery bypass grafting (CABG) and health-related quality of life (HRQoL).
Methods. For this cross‐sectional survey, we recruited patients aged more than 60 years old and who had received CABG within the recent one month. All patients were required to (1) responds to three HRQoL questionnaires, including Medical Outcomes Study 36-item Short-Form Health Survey, World Health Organization HRQoL, and MacNew HRQoL after myocardial infraction and to undergo (2) symptom-limited exercise testing, (3) a pulmonary function, (4) a six-minute walking test, and (5) muscle strength tests.
Results. Older patients who had received CABG had lower scores in all aspects of the three questionnaires. Only peak oxygen consumption showed a significant positive correlation with the physical domain of MacNew (Spearman rho=0.395, p=0.031). We found no significant correlation between the pulmonary function and any aspect of the three questionnaires. We found moderately positive correlations between muscle strength and the physical/psychological/social aspects of the three questionnaires (Spearman rho= 0.373-0.680, p=0.001-0.042). Stepwise regression analysis revealed that muscle strength was the main factor that influenced the physical domain of HRQoL (p=0.001-0.034).
Conclusion. Patients more than 60 years old had poorer HRQoL after CABG than their healthy peers. Muscle strength is the most important factor influencing the physical domain of HRQoL.