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

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 d、术后7 d及出院当天的POMS-SF评分、PSQI量表评分、疼痛评分呈正相关(P<0.05)。(4)结构方程模型拟合结果显示,df/χ2=3.82,RMSEA=0.040,NFI=0.940,RFI=0.092,TLI=0.910,IFI=0.950,表示该模型拟合程度较好。冠心病患者冠状动脉旁路移植术前疼痛评分、PSQI量表评分对其疲劳程度有直接影响(P<0.05);患者术后3 d疼痛评分、PSQI量表评分、POMS-SF评分对其疲劳程度有直接影响(P<0.05);患者术后7 d POMS-SF评分对其疲劳程度有直接影响(P<0.05);患者出院当天疼痛评分、PSQI量表评分对其疲劳程度有间接影响(P<0.05)。结论冠心病患者冠状动脉旁路移植术后3 d疲劳程度最严重,且年龄、文化程度、术后并发症、POMS-SF评分、疼痛评分是冠心病患者术后3 d疲劳程度的影响因素,疼痛、情绪、睡眠质量可通过相互作用影响其疲劳程度,临床可重点关注上述因素以缓解患者疲劳状态,改善患者预后。

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

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,ageOR=0.297,95%CI(0.166,0.531)],educational levelbelow primary school:OR=34.226,95%CI(3.428,341.737);primary school:OR=35.339,95%CI(4.567,273.483);junior school:OR=13.280,95%CI(1.530,115.455)],postoperative complicationsOR=2.719,95%CI(1.380,5.356)],POMS-SF scoreOR=1.101,95%CI(1.052,1.152)],pain scoreOR=1.528,95%CI(1.194,1.956)]were the influencing factors of postoperative 3 days fatigue degree of CHD patients(P<0.05).(3)Pearson correlation analysis showed that preoperative fatigue VAS score was respectively positively correlated with preoperative PSQI scale score and pain score(P<0.05);fatigue VAS score was respectively positively correlated with PAOM-SF score,PSQI scale score and pain score at postoperative 3 days,postoperative 7 days and discharged day(P<0.05).(4)The results of the structural equation model showed that,df/χ2=3.82,RMSEA=0.040,NFI=0.940,RFI=0.092,TLI=0.910,IFI=0.950,indicated that the model had a good fitting degree.Preoperative pain score and PSQI score had direct effects on fatigue degree of CHD patients(P<0.05);postoperative 3 days pain score,PSQI scale score and POMS-SF score had direct effects on fatigue degree of CHD patients(P<0.05);postoperative 7 days POMS-SF score had direct effects on fatigue degree of CHD patients(P<0.05);pain score and PSQI scale score at discharged day had indirect effects on fatigue degree of CHD patients(P<0.05).Conclusion Fatigue at postoperative 7 days is the most serious in patients with CHD after CABG,and age,educational level,postoperative complications,POMS-SF score and pain score are the influencing factors of fatigue at postoperative 3 days of CHD patients;pain,mood,sleep quality interaction affect the degree of fatigue,these factors should be focused clinically to alleviate patients’fatigue and improve the prognosis of patients.