冠心病患者冠状动脉旁路移植术后疲劳现状、影响因素及路径分析  

Fatigue Status,Influencing Factors Analysis and Path Analysis after Coronary Artery Bypass Grafting in Patients with Coronary Heart Disease

作　　者：李可心 杨秀兰[2] 郑淑梅[2] 周立芹[3] 刘玉珍[2] 高春枝[3] LI Kexin;YANG Xiulan;ZHENG Shumei;ZHOU Liqin;LIU Yuzhen;GAO Chunzhi(Nursing and Rehabilitation College,North China University of Science and Technology,Tangshan 063000,China;Department of Nursing,Tangshan Gongren Hospital,Tangshan 063000,China;Cardiac Surgery,Tangshan Gongren Hospital,Tangshan 063000,China)

机构地区：[1]华北理工大学护理与康复学院,河北省唐山市063000 [2]唐山工人医院护理部,河北省唐山市063000 [3]唐山工人医院心外科,河北省唐山市063000

出　　处：《实用心脑肺血管病杂志》2021年第4期38-44,共7页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：河北省2018年医学科学研究重点课题计划(20181261)。

摘　　要：背景近年来冠心病发病率不断升高,冠状动脉旁路移植术是临床治疗冠心病的有效手段之一,但患者术后疲劳状况逐渐引起重视。目的探讨冠心病患者冠状动脉旁路移植术后疲劳现状及其影响因素,并进行路径分析。方法选取唐山工人医院、开滦总医院2019年8月—2020年5月收治的行冠状动脉旁路移植术的冠心病患者324例,记录患者术前、术后3 d、术后7 d及出院当天疲劳视觉模拟评分量表(VAS)、简式简明心境问卷(POMS-SF)、匹兹堡睡眠质量指数(PSQI)量表、疼痛评分。采用多因素Logistic回归分析探讨冠心病患者术后3 d疲劳程度的影响因素;采用Pearson相关分析及路径分析探讨冠心病患者冠状动脉旁路移植术不同时间节点VAS评分、POMS-SF评分、PSQI量表评分、疼痛评分之间的关系。结果(1)冠心病患者术前疲劳VAS评分为(2.5±1.5)分,术后3 d为(7.9±1.1)分,术后7 d为(5.8±1.1)分,出院当天为(3.4±1.1)分。患者术前、术后3 d、术后7 d、出院当天疲劳程度比较,差异有统计学意义(P<0.001)。(2)将术后3 d轻度疲劳患者分为轻度组(n=2),中度疲劳患者分为中度组(n=109),重度疲劳患者分为重度组(n=213)。三组患者性别、年龄、文化程度、术后并发症发生率及POMS-SF评分、PSQI量表评分、疼痛评分比较,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,年龄[OR=0.297,95%CI(0.166,0.531)]、文化程度[小学以下:OR=34.226,95%CI(3.428,341.737);小学:OR=35.339,95%CI(4.567,273.483);初中:OR=13.280,95%CI(1.530,115.455)]、术后并发症[OR=2.719,95%CI(1.380,5.356)]、POMS-SF评分[OR=1.101,95%CI(1.052,1.152)]、疼痛评分[OR=1.528,95%CI(1.194,1.956)]是冠心病患者术后3 d疲劳程度的影响因素(P<0.05)。(3)Pearson相关分析结果显示,冠心病患者术前疲劳VAS评分与术前PSQI量表评分、疼痛评分均呈正相关(P<0.05);术后3 d、术后7 d及出院当天疲劳VAS评分均分别与术后3 Background In recent years,the incidence of coronary heart disease(CHD)has been increasing.Coronary artery bypass grafting(CABG)is one of the effective methods in the clinical treatment of CHD,but the postoperative fatigue of patients has gradually attracted more and more attention.Objective To investigate the fatigue status and influencing factors after CABG in patients with CHD,and conduct path analysis.Methods A total of 324 cases of patients with CHD underwent CABG were selected in Tangshan Gongren Hospital and Kailuan General Hospital from August 2019 to May 2020.Scores of fatigue Visual Analogue Scale(VAS),Profile of Mood States-Short Form(POMS-SF),Pittsburgh Sleep Quality Index(PSQI)scale and pain were estimated at the time points of preoperative,postoperative 3 days,postoperative 7 days and discharged day.Multivariate Logistic regression analysis was used to investigate the influencing factors for fatigue at postoperative 3 days.Pearson correlation analysis and path analysis were used to investigate the relationship among fatigue VAS score,POMS-SF score,PSQI scale score and pain score at different time points of CABG.Results(1)The fatigue VAS scores of CHD patients were respectively(2.5±1.5),(7.9±1.1),(5.8±1.1),(3.4±1.1)at the day before operation,postoperative 3 days,postoperative 7 days and discharged day.There were significant differences of fatigue degree at the day before operation,postoperative 3 days,postoperative 7 days and discharged day(P<0.001).(2)At postoperative 3 days,patients with mild fatigue were divided into mild group(n=2),patients with moderate fatigue were divided into moderate group(n=109)and patients with severe fatigue were divided into severe group(n=213).There were significant differences in gender,age,educational level,incidence of postoperative complications,POMS-SF score,PSQI scale score and pain score in the three groups(P<0.05).Multivariate Logistic regression analysis showed that,age[OR=0.297,95%CI(0.166,0.531)],educational level[below primary school:OR=34.226,95%CI(3.4

关 键 词：冠心病 冠状动脉旁路移植术 疲劳现状 路径分析 

分 类 号：R543.3[医药卫生—心血管疾病]