Abstract: Background　Coronary artery bypass grafting has become an important treatment for coronary artery disease（CHD）．With the improvement of surgical techniques and instruments，more than 30 000 cases of CHD receive this procedure every year in China，and the number is increasing．Post-procedure levels of physiological indicators have been well noted，while problems related to psychological rehabilitation have been ignored by clinicians previously．Objective　To investigate the effect of exercise intervention on health-related quality of life in middle-aged patients after off-pump coronary artery bypass grafting（OPCAB）．Methods　A total of 348 middle-aged patients with OPCAB were selected from the single operation group from Department of Cardiac Surgery，Beijing Anzhen Hospital，Capital Medical University from January 2014 to June 2017，and divided into exercise group（144 cases）and control group（204 cases）according to whether they could meet the exercise criteria 6 to 18 months after surgery．Two groups were compared at postoperative 6 and 18 months，respectively，in terms of ejection fraction（EF）and left ventricular end-diastolic diameter（LVEDD），the scale sore and domain scores 〔physical functioning（PF），physical role functioning（RP），bodily pain（BP），general health perceptions（GH），vitality（VT），social role functioning（SF），emotional role functioning（RE），mental health（MH）〕 and physical component summary（PCS）and mental component summary（MCS）scores of the 36-Item Short Form Health Survey（SF-36）．Results　At 6 months after operation，there were no significant differences in the mean values of EF and LVEDD，mean scores of PF，RP，BP，GH，VT，SF，RE，MH，PCS and MCS，as well as the scale score of the SF-36 between the two groups（P>0.05）．Eighteen months after operation，except the mean value of LVEDD was still similar in both groups（P>0.05），other 12 indictors in the exercise group were all much better than those in the control group（P<0.05）．Compared to the results of 6 months post-procedure，the mean value of LVEDD decreased significantly and mean scores of other 12 indicators increased significantly at 18 months post-procedure in both groups（P<0.05）．Conclusion　In middle-aged patients after OPCAB，the standard exercise intervention may significantly improve the health-related quality of life．

Key words: Coronary disease；Coronary artery bypass, off-pump ；Middle aged；Health-related quality of life；Exercise therapy；Quality of life

摘要： 背景　冠状动脉旁路移植术已经成为治疗冠心病的重要方法，随着手术技术和器械的改进，国内每年接受该手术的患者逾30 000例，且数量持续增加。既往医生对术后患者更多的关注其生理指标的康复效果，而忽视了患者心理康复的相关问题。目的　探讨运动干预对非体外冠状动脉旁路移植术（OPCAB）后中年患者健康相关生存质量（HRQOL）的影响。方法　选择2014年1月—2017年6月在首都医科大学附属北京安贞医院心脏外科单一手术组行OPCAB的中年患者348例作为研究对象，并按照术后6~18个月是否能够达到运动标准分为运动组（144例）和对照组（204例）。于术后6个月和18个月分别测定患者的射血分数（EF）及左心室舒张末期内径（LVEDD），并应用简明健康调查量表（SF-36）进行测评，记录生理机能（PF）、生理角色限制（RP）、躯体疼痛（BP）、总体健康（GH）、活力（VT）、社会功能（SF）、情感角色限制（RE）、心理健康（MH）、生理健康内容（PHC）、心理健康内容（MHC）评分及SF-36总分，比较两组间术后6个月及术后18个月各指标间有无差异。结果　术后6个月，两组间EF、LVEDD、PF评分、RP评分、BP评分、GH评分、VT评分、SF评分、RE评分、MH评分、PHC评分、MHC评分、SF-36总分比较，差异均无统计学意义（P>0.05）。术后18个月，运动组EF、PF评分、RP评分、BP评分、GH评分、VT评分、SF评分、RE评分、MH评分、PHC评分、MHC评分、SF-36总分均高于对照组（P<0.05）；术后18个月，两组间LVEDD比较，差异无统计学意义（P>0.05）。对照组及运动组术后18个月的EF、PF评分、RP评分、BP评分、GH评分、VT评分、SF评分、RE评分、MH评分、PHC评分、MHC评分、SF-36总分均高于术后6个月，LVEDD低于术后6个月（P<0.05）。结论　达标的运动干预可以明显提升OPCAB后中年患者的HRQOL。

关键词: 冠心病；冠状动脉旁路移植术, 非体外循环；中年人；健康相关生存质量；运动疗法；生活质量