目的 探讨心脏瓣膜置换患者术后疲劳发展轨迹的类别及影响因素。方法 采用便利抽样法,通过一般资料调查表、中文版多维疲劳量表、疼痛数字评分表、汉密尔顿焦虑抑郁量表和匹兹堡睡眠质量指数量表对2023年8月至2024年7月在我院接受心脏瓣膜置换术的264例患者进行问卷调查。分别在随访第1、2、3、4、5、6个月时采用中文版多维疲劳量表对患者疲劳程度进行评估。通过潜变量增长混合模型识别心脏瓣膜置换患者术后疲劳发展轨迹,采用Logistic回归模型分析其影响因素。结果 共216例患者完成6次随访,心脏瓣膜置换患者术后疲劳发展轨迹分为3种类别,分别为疲劳稳定（32.87%）、疲劳升高（16.67%）和疲劳下降（50.46%）。单因素分析结果表明,心脏瓣膜置换患者术后疲劳发展轨迹的3种潜在类别在年龄、心功能分级、疼痛、焦虑、抑郁、睡眠障碍上的差异具有统计学意义。Logistic回归分析结果表明,心功能分级、焦虑、抑郁、睡眠障碍是心脏瓣膜置换患者术后疲劳发展轨迹类别的影响因素。结论 心脏瓣膜置换患者术后疲劳发展轨迹存在异质性,心功能分级、焦虑、抑郁、睡眠障碍是心脏瓣膜置换患者术后疲劳发展轨迹的重要影响因素。
Abstract
Objective To explore the types and influencing factors of postoperative fatigue development trajectories in patients undergoing cardiac valve replacement. Methods A questionnaire survey was conducted among 264 patients who underwent heart valve replacement surgery in our hospital from August 2023 to July 2024 using the convenience sampling method. The instruments included the general information questionnaire, the Chinese version of the Multidimensional Fatigue Scale, the Numerical Rating Scale for Pain, the Hamilton Anxiety and Depression Scale, and the Pittsburgh Sleep Quality Index Scale. The fatigue degree of the patients was evaluated by using the Chinese version of the Multidimensional Fatigue Scale at the 1st, 2nd, 3rd, 4th, 5th and 6th months of follow-up respectively. The postoperative fatigue development trajectory of patients undergoing heart valve replacement was identified through the latent variable growth mixture model, and the influencing factors were analyzed by logistic regression. Results A total of 216 patients completed 6 follow-ups. There were three categories of postoperative fatigue development trajectories in patients undergoing heart valve replacement, namely stable fatigue (32.87%), elevated fatigue (16.67%), and decreased fatigue (50.46%). The results of univariate analysis indicated that there were statistically significant differences among the three potential categories of postoperative fatigue development trajectories in patients undergoing heart valve replacement in terms of age, cardiac function classification, pain, anxiety, depression, and sleep disorders. The results of logistic regression analysis indicated that cardiac function classification, anxiety, depression, and sleep disorders were the influencing factors of the category of postoperative fatigue development trajectory in patients undergoing heart valve replacement. Conclusion There is heterogeneity in the postoperative fatigue development trajectory of patients undergoing heart valve replacement. Cardiac function classification, anxiety, depression, and sleep disorders are important influencing factors for the postoperative fatigue development trajectory of patients undergoing heart valve replacement.
关键词
潜变量增长混合模型 /
心脏瓣膜置换术 /
术后疲劳 /
发展轨迹 /
影响因素
Key words
latent variable growth mixture model /
heart valve replacement surgery /
postoperative fatigue /
development trajectory /
influencing factors
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基金
首都医科大学附属北京朝阳医院金种子基金“LPA-LPA2诱导内皮细胞增殖促进CABG术后静脉移植物衰败的机制研究”（CYJZ202228）
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