经导管主动脉瓣置换术后心脏康复依从性轨迹及影响因素的决策树分析  

Decision tree analysis of compliance trajectories and influencing factors in cardiac rehabilitation after transcatheter aortic valve replacement

作　　者：付珏 管玉珍[1] Fu Jue;Guan Yuzhen(Department of Cardiovascular Surgery,Jiangsu Provincial People’s Hospital,Jiangsu Nanjing 210000,China)

机构地区：[1]江苏省人民医院心脏大血管外科监护室,南京210000

出　　处：《中国体外循环杂志》2025年第1期58-63,71,共7页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金项目(82202402)。

摘　　要：目的探究不同主动脉瓣狭窄(AS)患者行经导管主动脉瓣置换术(TAVR)术后的心脏康复依从性(CRA)变化轨迹差异并分析其影响因素,以期为TAVR术后AS患者的康复运动依从性的改善方案提供参考。方法采用随机便利抽样法,选择182例行TAVR治疗的AS患者为研究对象,采用一般资料调查表、医院焦虑抑郁量表、CRA量表、疾病感知问卷、心脏康复相关信息知晓度问卷对患者进行调查,另分别于出院时、出院后1个月、出院后3个月、出院后6个月追踪患者心脏康复依从性水平,采用潜类别增长模型识别CRA亚组,采用决策树模型分析CRA亚型的核心影响因素。结果AS患者TAVR术后CRA变化轨迹分为CRA升高组(75.82%)和CRA降低组(24.18%)2个潜在类别。吸烟史、文化程度、心脏康复信息知晓情况、合并其他疾病数量、疾病感知良好以及久坐习惯均是影响AS患者TAVR术后CRA变化轨迹亚组的影响因素,其中心脏康复信息知晓得分属于最为重要的影响因素,信息增益为0.530。结论AS患者TAVR术后CRA呈不同变化轨迹,医务人员可制定以提高心脏康复信息知晓得分为主的干预方案,以改善AS患者TAVR术后的CRA水平。Objective To explore the differences in the trajectories of cardiac rehabilitation compliance among patients with various degrees of aortic stenosis(AS)after undergoing transcatheter aortic valve replacement(TAVR)and analyze the influencing factors,aiming to provide a reference for improving rehabilitation exercise compliance among AS patients post-TAVR.Methods A random convenience sampling method was employed to select 182 patients with AS who underwent TAVR as the study subjects.The patients were surveyed using a general information questionnaire,Hospital Anxiety and Depression Scale Cardiac Rehabilitation Adherence Scale,Illness Perception Questionnaire,and Cardiac Rehabilitation Information Awareness Questionnaire.Additionally,the patients’cardiac rehabilitation adherence levels were followed up at the time of discharge,1 month,3 months,and 6 months post-discharge.Latent Class Growth Modeling was utilized to identify subgroups of cardiac rehabilitation adherence,and a decision tree model was employed to analyze the core influencing factors of these subgroups.Results AS patients with cardiac rehabilitation compliance after TAVR were divided into two potential categories:increased cardiac rehabilitation compliance group(75.82%)and decreased cardiac rehabilitation compliance group(24.18%).Smoking history,educational level,knowledge of cardiac rehabilitation information,number of combined diseases,good perception of disease and sedentary habits were all influencing factors on the change trajectory of cardiac rehabilitation compliance of AS patients after TAVR.Among them,the score of cardiac rehabilitation information awareness was the most important influencing factor,and the information gain was 0.530.Conclusion The cardiac rehabilitation compliance of AS patients after TAVR shows different change tracks.Medical staff can develop intervention programs focusing on improving the cardiac rehabilitation information awareness score to improve the cardiac rehabilitation compliance level of AS patients after TAVR.

关 键 词：经导管主动脉瓣置换术 心脏康复依从性 潜类别增长模型 轨迹 决策树 

分 类 号：R65[医药卫生—外科学]