Relationship between gastrointestinal symptoms and quality of life in patients with atrial fibrillation after different ablation methods
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摘要:
目的 比较不同射频消融术式对于心房颤动(以下简称房颤)患者的影响。 方法 纳入2019年9月—2020年5月在江苏省人民医院心内科住院的房颤患者87例,分为环肺静脉射频消融(CPVI)组(44例)和环肺静脉联合左房后壁电隔离术(CPVI-LAPWI)射频消融组(43例),采用胃肠道症状分级量表(GSRS)和房颤特异生活质量量表(AFEQT)评估2组患者术后情况。 结果 CPVI-LAPWI组腹痛(34.88% vs. 4.55%, P < 0.001)、胃灼热(62.79% vs. 22.73%, P < 0.001)的发生率显著高于CVPI组;而排气增多(11.63% vs. 29.54%, P=0.039)和排便不尽感(6.98% vs. 27.27%, P=0.013)的发生率显著低于CVPI组。根据GSRS评分,CPVI-LAPWI组患者腹痛(P=0.005)、返流(P < 0.001)和便秘(P=0.033)症状比CPVI组严重。87例房颤患者术后AFEQT评分与胃肠道症状评分呈负相关(r=-0.359,P=0.001),CPVI-LAPWI组及CVPI组相关系数分别为-0.440(P=0.003)、-0.328(P=0.030)。 结论 房颤患者2种射频消融术式术后生活质量与胃肠道症状密切相关。相较于CVPI组患者,CPVI-LAPWI组患者术后应更加重视对腹痛、胃灼热、返流和便秘等胃肠道症状的护理。 Abstract:Objective To compare the differences in patients with atrial fibrillation (AF) after two different ablation methods. Methods From September 2019 to May 2020, a total of 87 patients with ablation of AF who were admitted at the Department of Cardiology, Jiangsu Province Hospital were analysed. The patients were divided into two groups: circumferential pulmonary vein ablation (CPVI) group (44 patients) and circumferential pulmonary vein combined with left atrial posterior wall isolation (CVPI-LAPWI) group (43 patients). We evaluated the relevant symptoms using the Gastrointestinal Symptom Rating Scale (GSRS) and Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) scale. Results The incidences of abdominal pain (34.88% vs. 4.55%, P < 0.001) and heartburn (62.79% vs. 22.73%, P < 0.001) in the CPVI-LAPWI group were significantly higher than those in the CPVI group. However, the incidences of increased exhaustion (11.63% vs. 29.54%, P=0.039) and incomplete defecation (6.98% vs. 27.27%, P=0.013) were significantly lower in the CPVI-LAPWI group than in the CPVI group. According to the GSRS score, the symptoms of abdominal pain (P=0.005), reflux (P < 0.001) and constipation (P=0.033) in the CPVI-LAPWI group were more serious than those in the CPVI group. A negative correlation was observed between the AFEQT score and the GSRS score in all AF patients (r=-0.359, P=0.001). The correlation coefficient of the CPVI-LAPWI group was -0.440 (P=0.003), and that of the CPVI group was -0.328 (P=0.030). Conclusion The quality of life of patients with AF after ablation is closely related to gastrointestinal symptoms. Nurses should pay more attention to abdominal pain, reflux and heartburn of patients undergoing CPVI-LAPWI. -
表 1 EHRA房颤症状评分标准
评分 症状严重程度 内容 1 无 房颤不引起任何症状 2a 轻度 日常活动不受房颤相关症状的影响 2b 中度 日常活动不受房颤相关症状的影响,但受到症状困扰 3 严重 日常活动受到房颤相关症状的影响 4 致残 正常日常活动终止 表 2 NYHA分级
分级 内容 Ⅰ级 体力活动不受限,日常活动不引起过度的乏力、呼吸困难或心悸 Ⅱ级 体力活动轻度受限,休息时无症状,日常活动即可引起乏力、心悸、呼吸困难或心绞痛 Ⅲ级 体力活动明显受限,休息时无症状,轻于日常活动即可引起上述症状 Ⅳ级 不能从事任何体力活动,休息时亦有充血性心衰或心绞痛症状,任何体力活动后加重 表 3 2组心房颤动患者一般资料比较
项目 CPVI组(n=44) CPVI-LAPWI组(n=43) 统计量 P值 年龄(x±s, 年) 60.0±14.1 60.8±9.9 -1.469a 0.145 性别(男/女, 例) 30/14 28/15 < 0.001b 0.990 身高(x±s, cm) 167.9±8.5 167.1±8.6 0.446a 0.657 体重(x±s, kg) 69.3±11.6 71.4±11.1 -0.854a 0.396 BMI(x±s) 24.6±2.9 25.5±3.0 -1.530a 0.130 入院脉压差(x±s, mm Hg) 50.0±13.8 47.3±14.7 0.876a 0.384 术后脉压差(x±s, mm Hg) 49.1±12.8 47.5±8.8 0.677a 0.500 入院心率(x±s, 次/min) 82.2±14.7 84.3±20.5 -0.544a 0.588 术后心率(x±s, 次/min) 78.2±14.4 75.5±12.0 0.967a 0.337 高血压[例(%)] 20(45.45) 30(69.76) -2.280b 0.023 冠心病[例(%)] 5(11.36) 7(16.28) -0.661b 0.509 糖尿病[例(%)] 5(11.36) 11(25.58) -1.702b 0.089 高脂血症[例(%)] 2(4.54) 2(4.65) -0.023b 0.981 睡眠呼吸暂停综合征[例(%)] 2(4.54) 5(11.63) -1.207b 0.227 文化程度[例(%)] -0.577c 0.564 小学及以下 9(20.45) 13(30.23) 初中 12(27.27) 10(23.26) 高中 16(36.36) 12(27.91) 大学及以上 7(15.91) 8(18.60) 婚姻状况[例(%)] -1.358b 0.174 已婚 40(90.91) 42(97.67) 未婚 1(2.27) 0(0.00) 丧偶 3(6.81) 1(2.33) 无吸烟史[例(%)] 37(84.09) 32(74.42) -1.062b 0.288 无饮酒史[例(%)] 35(79.55) 35(81.39) -0.227b 0.820 注:a为t值,b为χ2值,c为U值。1 mm Hg=0.133 kPa。 表 4 2组心房颤动患者房颤病史及相关指标比较情况
组别 例数 EHRA评分(例) NYHA分级(例) LVEF(x±s, %) 1 2a 2b 3 4 Ⅰ级 Ⅱ级 Ⅲ级 Ⅳ级 CPVI组 44 4 12 22 6 0 17 23 4 0 62.4±3.6 CPVI-LAPWI组 43 4 9 20 9 1 19 21 2 1 61.4±5.7 统计量 -0.957a -0.551a 0.976b P值 0.339 0.582 0.335 注:a为U值,b为t值。 表 5 2组房颤射频消融术后患者胃肠道症状发生情况[例(%)]
组别 例数 腹痛 胃灼热 酸反流 上腹部紧迫感 恶心和呕吐 腹鸣 腹胀 嗳气 CPVI组 44 2(4.55) 10(22.73) 7(15.91) 4(9.09) 10(22.73) 5(11.36) 8(18.18) 9(20.45) CPVI-LAPWI组 43 15(34.88) 27(62.79) 9(20.93) 9(20.93) 13(30.23) 2(4.65) 9(20.93) 7(16.28) χ2值 12.731 14.281 0.365 2.398 0.630 1.324 0.121 0.253 P值 < 0.001 < 0.001 0.546 0.121 0.427 0.250 0.728 0.615 组别 例数 排气增多 排便减少 排便增多 稀便 硬便 排便紧迫感 排便不尽感 CPVI组 44 13(29.55) 4(9.09) 5(11.36) 9(20.45) 4(9.09) 7(15.91) 12(27.27) CPVI-LAPWI组 43 5(11.63) 4(9.30) 4(9.30) 5(11.63) 1(2.33) 4(9.30) 3(6.98) χ2值 4.255 0.001 0.100 1.255 1.838 0.859 6.278 P值 0.039 0.973 0.752 0.263 0.175 0.354 0.013 表 6 2组房颤射频消融术患者术后胃肠道症状GSRS评分比较[M(P25, P75), 分]
组别 例数 腹痛 反流 腹泻 消化不良 便秘 CPVI组 44 2.00(2.00, 2.75) 2.00(2.00, 3.00) 4.00(4.00, 5.75) 4.00(4.00, 5.75) 3.00(3.00, 3.00) CPVI-LAPWI组 43 3.00(2.00, 3.00) 3.00(2.00, 3.00) 4.00(4.00, 5.00) 4.00(4.00, 5.00) 3.00(3.00, 4.00) Z值 -2.829 -3.339 -0.178 -0.754 -2.136 P值 0.005 < 0.001 0.859 0.451 0.033 表 7 2组心房颤动患者术后胃肠道症状评分与生活质量评分的相关性分析[M(P25, P75), 分]
组别 例数 胃肠道症状评分 房颤术后生活质量评分 r值 P值 CPVI组 44 2.50(0.25, 4.00) 63.43(51.39, 79.63) -0.328 0.030 CPVI-LAPWI组 43 3.00(1.00, 4.00) 65.74(58.33, 74.07) -0.440 0.003 合计 87 3.00(1.00, 4.00) 64.81(54.63, 75.93) -0.359 0.001 -
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