Prospektive Untersuchung zu den Auswirkungen aortokoronarer Bypassoperationen auf die gesundheitsbezogene Lebensqualität, kognitive Performanz und emotionale Befindlichkeit im 6-Monats-Verlauf

Zusammenfassung

Heutzutage wird der Erfolg von routinemäßig durchgeführten aortokoronaren Bypassoperationen (CABG: coronary artery bypass graft) nicht nur auf der Grundlage von klassischen Bewertungskriterien wie beispielsweise Mortalitätsraten, sondern auch vor dem Hintergrund ihrer Auswirkungen auf die biopsychosozialen Dimensionen beurteilt. Ziel dieser Studie war es, Veränderungen der gesundheitsbezogenen Lebensqualität, der kognitiven Performanz und der emotionalen Befindlichkeit nach einer elektiv durchgeführten CABG im 6-Monats-Verlauf zu evaluieren und Zusammenhänge zwischen kognitiven Einbußen, Depression, posttraumatischen Stress-Symptomen und der Lebensqualität zu untersuchen. In einer prospektiv durchgeführten Studie konnten insgesamt 138 der ursprünglich 147 Patienten 6 Monate nach einer elektiv durchgeführten CABG nachuntersucht werden. Hierbei wurden die gesundheitsbezogene Lebensqualität (SF-36) und die kognitive Performanz (SKT) evaluiert sowie das Vorliegen depressiver Symptome (BDI) und posttraumatischer Belastungssymptome (PTSS-10) erfasst. Im Hinblick auf die gesundheitsbezogene Lebensqualität war festzuhalten, dass sich 6 Monate nach CABG die Lebensqualitätskennziffern in allen acht SF-36-Gesundheitskategorien signifikant im Vergleich zu den präoperativ erhobenen SF-36-Werten verbessert hatten. Jedoch hatten bei der Nachuntersuchung 6 Monate postoperativ Patienten mit Depression im Vergleich zu Patienten ohne Depression in allen der insgesamt acht SF-36-Gesundheitskategorien signifikant niedrigere SF-36-Werte. Patienten mit posttraumatischer Belastungsstörung (PTBS) im Vergleich zu Patienten ohne PTBS zeigten signifikant ungünstigere SF-36-Lebensqualitätskennziffern in sechs der acht SF-36-Kategorien. Schließlich wiesen im 6-Monats-Verlauf Patienten mit kognitiven Beeinträchtigungen im Vergleich zu Patienten ohne kognitive Beeinträchtigungen signifikant schlechtere SF-36-Werte in der Kategorie körperliche Funktionsfähigkeit auf. Wir raten frühzeitig zu einer umfänglichen biopsychosozialen Diagnostik und Therapie von CABG-operierten Patienten, damit bei ihnen emotionale Befindlichkeitsstörungen und CABG-assoziierte kognitive Leistungsdefizite ehest möglich behandelt und so ihre Lebensqualität zeitig nach dem herzchirurgischen Eingriff verbessert werden kann.

Abstract

The success of routine coronary artery bypass graft surgery (CABG) is now no longer judged solely by its effects on traditional end points such as mortality rates but by its influence on biopsychosocial dimensions. The aim of this study was to assess the course of health-related quality of life, cognitive and emotional change during the six months after elective CABG, and to investigate how cognitive impairments, depression and posttraumatic stress symptoms were related to quality of life. In a prospective study, we followed up for 6 months 138 of the original 147 patients who had undergone elective CABG surgery. Preoperatively, and at 6 months after surgery, a series of psychometric observer-rating and self-rating scales were administered to evaluate cognitive functioning (SKT), depressive symptoms (BDI), posttraumatic stress symptoms (PTSS-10), and health-related quality of life (SF-36 Health Status Questionnaire). The measurements of health-related quality of life (HRQOL) indicated significantly higher SF-36 values on all of the eight health-related domains from preoperative to 6-month follow-up assessments. However, at 6-month follow-up, patients with clinical depression had significantly lower SF-36 values on all of the eight health-related domains when compared with patients without depression. Also, at 6-month follow-up, patients with posttraumatic stress disorder (PTSD) had significantly lower SF-36 values on six of the eight SF-36 health categories when compared with patients without PTSD. Finally, at 6-month follow-up, patients with cognitive deficits had significantly lower SF-36 values on physical functioning when compared with patients without cognitive impairments. We underscore the need for early and comprehensive bio-psycho-social diagnosis and therapy of post-CABG patients in order to treat emotional distress and CABG-related cognitive impairments and enhance patients’ quality of life at an early stage after cardiac surgery.

Schlüsselwörter

aortokoronare Bypassoperation - extrakorporale Zirkulation - kognitive Beeinträchtigungen - Depression - posttraumatische Belastungsstörung - gesundheitsbezogene Lebensqualität - Konsiliar- und Liaisonpsychiatrie

Keywords

coronary artery bypass graft surgery - cardiopulmonary bypass - cognitive impairments - depression - posttraumatic stress disorder - health-related quality of life - consultation-liaison psychiatry

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