明尼苏达心力衰竭生活质量调查表（明尼苏达大学， 1986 年）
在最近的一个月内，您的心力衰竭对您的生活的影响
很少
Did your heart failure prevent you from living as you wanted during the
无 Very
NO
last month by
Little
您的踝关节或腿出现肿胀？
1.
causing swelling in your ankles or legs, etc.?
1
2
3
使您在白天被迫坐下或躺下休息？
2.
making you sit or lie down to rest during the day? 0
1
2
3
使您在步行或上楼梯困难？
3.
making your walking about or climbing stairs difficult?
1
2
3
使您在家中或院子里工作困难？
4.
making your working around the house or yard difficult? 0
1
2
3
使您离开家出门困难？
5.
making your going places away from home difficult? 0
1
2
3
使您晚上睡眠状况困难？
6.
making your sleeping well at night difficult? 0
1
2
3
使您和您的朋友或家人一起做事困难？
7.
making your relating to or doing things with your friends or
1
2
3
family difficult?
使您做获得收入的工作困难？
8.
making your working to earn a living difficult?
1
2
3
9.
使您的做娱乐、体育活动或喜好的事情困难？
1
2
3
making your recreational pastimes, sports or hobbies difficult?
使您的性生活困难 ?
10.
making your sexual activities difficult? 0
1
2
3
11.
使您对您喜欢的食物也吃的很少？
1
2
3
making you eat less of the foods you like?
使你有呼困难？
12.
making you short of breath?
1
2
3
.
使您疲劳、乏力、或没有精力？
13.0123 making you tired, fatigued, or low on energy?
使您在医院住院？
14.0123 making you stay in a hospital?
使您因就医花钱？
15.0123 costing you money for medical care?
使您因为治疗出现了副作用？
16.0123 giving you side effects from treatments?
使您觉得自己是家人或朋友的负担？
17.0123 making you feel you are a burden to your family or friends?
使您觉得不能控制自己的生活？
18.0123 making you feel a loss of self-control in your life?
使得您焦虑？
19.0123 making you worry?
使您不能集中注意力或记忆力下降？
20.0123 making it difficult for you to concentrate or remember things?
使您情绪低落？
21.0123 making you feel depressed?
.。