心房颤动导管消融伴永久起搏器置入患者术后失访的影响因素分析  

Analysis of Influencing Factors on Loss of Follow-up in Patients after Atrial Fibrillation Catheter Ablation and Permanent Pacemaker Implantation

作　　者：陈小然 王琳[1] CHEN Xiaoran;WANG Lin(Department of Cardiovascular Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,南京210029

出　　处：《医学综述》2020年第23期4781-4784,F0003,共5页Medical Recapitulate

摘　　要：目的探讨心房颤动导管消融伴永久起搏器置入患者术后失访的影响因素。方法回顾性分析2016年1月至2019年2月在南京医科大学第一附属医院完成永久起搏器安装的92例房室传导阻滞患者的临床资料,通过检索南京医科大学第一附属医院电子病历系统,记录患者基线资料,采用单因素与多因素Logistic回归分析心房颤动导管消融伴永久起搏器置入患者术后失访的影响因素。结果入组的92例心房颤动导管消融伴永久起搏器置入患者中,失访36例,占39.13%。文化程度高中及以下的失访率高于大专及以上的患者[66.67%(20/30)比25.81%(16/62)],无配偶/丧偶的失访率高于在婚患者[59.09%(13/22)比32.86%(23/70)],认知水平<75分的失访率高于认知水平≥75分患者[83.33%(20/24)比23.53%(16/68)],焦虑自评量表(SAS)≥50分的失访率高于SAS <50分患者[80.95%(17/21)比26.76%(19/71)],抑郁自评量表(SDS)≥53分的失访率高于SDS <53分患者[80.00%(16/20)比27.78%(20/72)],无起搏器相关并发症患者失访率高于有起搏器相关并发症患者[47.06%(32/68)比16.67%(4/24)],医疗费用自费患者失访率高于医疗保险/商业保险患者[94.29%(33/35)比5.26%(3/57)],居住地在农村的失访率高于城市患者[86.49%(32/37)比7.27%(4/55)](P <0.05)。多因素Logistic回归分析结果显示,文化程度、婚否、患者认知水平、心理状态、居住地、医疗费用支付方式、起搏器相关并发症是心房颤动导管消融伴永久起搏器置入患者术后失访的影响因素(P <0.05)。结论心房颤动导管消融伴永久起搏器置入患者认知水平低下、心理状态不佳、自费、无起搏器相关并发症等可能造成术后失访,针对存在上述因素的患者临床应提高警惕,制订干预措施,以提高术后随访成功率。Objective To explore the influencing factors on loss of follow-up in patients after atrial fibrillation catheter ablation and permanent pacemaker implantation.Methods Clinical data of 92 patients with atrioventricular block who completed the installation of permanent pacemakers in the First Affiliated Hospital of Nanjing Medical University from Jan.2016 to Feb.2019 were collected and retrospective analyzed,and the baseline data of the patients were retrieved by searching the electronic medical record system of the First Affiliated Hospital of Nanjing Medical University.Univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of loss of follow-up.Results Among the 92 patients,36 were lost to follow-up,accounting for 39.13%.The rate of loss of follow-up of the patients with high school education and below was higher than that of junior college and above[66.67%(20/30)vs 25.81%(16/62)],the rate of the patients without a spouse/widowed was higher than those in marriage[59.09%(13/22)vs 32.86%(23/70)],the rate of the cognitive level<75 points was higher than that of the cognitive level≥75 points[83.33%(20/24)vs 23.53%(16/68)],the rate of of self rating anxiety scale(SAS)≥50 points was higher than that of SAS<50 points[80.95%(17/21)vs 26.76%(19/71)],the rate of self rating depression scale(SDS)≥53 points was higher than that of SDS<53 points[80.00%(16/20)vs 27.78%(20/72)],the rate of patients without pacemaker-related complications was higher than that of patients with pacemaker-related complications[47.06%(32/68)vs 16.67%(4/24)],the rate of the medical expense self-paid patients was higher than that of the medical insurance/commercial insurance patients[94.29%(33/35)vs 5.26%(3/57)],the rate of the patients in rural areas was higher than that in cities[86.49%(32/37)vs 7.27%(4/55)](P<0.05).The results of multivariate Logistic regression analysis showed that educational level,marriage status,patient′s cognitive level,mental state,place of residence,payment method of medi

关 键 词：心房颤动导管消融 永久起搏器置入 心理状态 术后失访 

分 类 号：R541.75[医药卫生—心血管疾病]