心房颤动患者症状群及其影响因素研究

doi:10.3761/j.issn.0254-1769.2020.08.015

摘要/Abstract

摘要：

目的探讨心房颤动患者的症状群特征,并分析影响症状群的主要因素。方法采用社会人口学及临床特征问卷、多伦多心房颤动严重程度量表的症状分量表对天津市某三级甲等综合医院心律失常门诊的203例心房颤动患者进行横断面调查,采用系统聚类分析提取症状群,并通过卡方检验和Kruskal-Wallis H秩和检验分析社会人口学因素及疾病特征对症状群分布情况的影响。结果该调查共回收有效问卷197份。心房颤动患者存在3个症状群:心脏症状群（心悸、胸痛）、疲劳症状群（休息时呼吸困难、疲乏、眩晕）和运动症状群（活动时呼吸困难、运动无耐力）。性别、心房颤动类型、BMI、血栓危险度评分、合并高血压、冠心病、心力衰竭是影响心房颤动患者症状群分布的主要因素。结论护士应加强女性、永久性心房颤动、合并疾病的心房颤动患者的症状识别,提供症状管理措施,改善疾病预后。

关键词: 心房颤动, 症状群, 症状管理, 聚类分析, 护理

Abstract:

Objective To identify the composition of symptom cluster in patients with atrial fibrillation and to explore the differences in the distribution of symptom clusters on sociodemographic variables and disease characteristics. Methods A cross-sectional survey was conducted in 197 patients with atrial fibrillation in the arrhythmia clinic of a tertiary general hospital in Tianjin,using the general information questionnaire and the symptom subscale of the University of Toronto AF Severity Scale（AFSS） as data collection instruments. Symptom clusters were extracted by systematic cluster analysis,and the effects of sociodemographic variables and disease characteristics on the distribution of symptom clusters were determined by chi-square test,and Kruskal-Wallis H rank sum test. Results There were 3 symptom clusters in atrial fibrillation patients,including cardiac symptom cluster（palpitation,chest pain）,fatigue symptom cluster（dyspnea at rest,fatigue,vertigo） and exertional symptom cluster（dyspnea during activity,exercise intolerance）. Gender,type of atrial fibrillation,body mass index,CHA₂DS₂-VAS_C score,combined hypertension,coronary heart disease,and heart failure were the main factors affecting the composition of the symptom clusters. Conclusion Symptom clusters can be helpful for patients with atrial fibrillation to detect symptoms early and seek medical help in time,as well as to provide theoretical support for clinical staff to implement more accurate and comprehensive symptom management for atrial fibrillation patients.

Key words: Atrial Fibrillation, Symptom Cluster, Symptom Management, Cluster Analysis, Nursing Care

葛红玥, 林梅, 许志英. 心房颤动患者症状群及其影响因素研究[J]. 中华护理杂志, 2020, 55(8): 1189-1196.

GE Hongyue, LIN Mei, XU Zhiying. Analysis of characteristics of patients with atrial fibrillation distributed by different symptom clusters[J]. Chinese Journal of Nursing, 2020, 55(8): 1189-1196.

图/表 5

表1 心房颤动患者的一般资料(n=197)

图1 心房颤动患者症状系统聚类树状图

表2 影响心脏症状群组成的因素分析（n=197）

表3 影响疲劳症状群组成的因素分析（n=197）

表4 影响运动症状群组成的因素分析（n=197）

参考文献 36

[1]	Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics-2018 update:a report from the American Heart Association[J]. Circulation, 2018,137(12):e67-e492. DOI URL PMID
[2]	Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J]. Eur Heart J, 2016,37(38):2893-2962. DOI URL PMID
[3]	Steg PG, Alam S, Chiang CE, et al. Symptoms,functional status and quality of life in patients with controlled and uncontrolled atrial fibrillation:data from the Realise AF cross-sectional international registry[J]. Heart, 2012,98(3):195-201. DOI URL PMID
[4]	Witkowski M, Bissinger A, Grycewicz T, et al. Asymptomatic atrial fibrillation in patients with atrial fibrillation and implanted pacemaker[J] Int J Cardiol, 2017,227:583-588. URL PMID
[5]	Gehi AK, Sears S, Goli N, et al. Psychopathology and symptoms of atrial fibrillation:implications for therapy[J]. J CardiovascElectrophysiol, 2012,23(5):473-478.
[6]	Pokushalov E, Romanov A, Katritsis DG, et al. Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation:a randomized comparison[J]. Heart Rhythm, 2013,10(9):1280-1286. DOI URL PMID
[7]	Seaborn GE, Todd K, Michael KA, et al. Heart rate variability and procedural outcome in catheter ablation for atrial fibrillation[J]. Ann Noninvasive Electrocardiol, 2014,19(1):23-33. DOI URL PMID
[8]	de Von HA, Vuckovic K, Ryan CJ, et al. Systematic review of symptom clusters in cardiovascular disease[J]. Eur J Cardiovasc Nurs, 2017,16(1):6-17. DOI URL PMID
[9]	宣凡馨, 李峥, 康晓凤, 等. 心力衰竭患者症状群的纵向研究[J]. 中华护理杂志, 2017,52(12):1450-1456.
[10]	李楠楠, 吴静, 周洁. 癌症患者症状群纵向研究现状综述[J]. 中华护理杂志, 2017,52(1):24-28.
[11]	Miaskowski C, Aouizerat BE, Dodd M, et al. Conceptual issues in symptom clusters research and their implications for quality-of-life assessment in patients with cancer[J]. J Natl Cancer Inst Monographs, 2007(37):39-46. DOI URL PMID
[12]	Huang TY, Moser DK, Hwang SL. Identification,associated factors,and prognosis of symptom clusters in Taiwanese patients with heart failure[J]. J Nurs Res, 2018,26(1):60-67. DOI URL PMID
[13]	宣凡馨, 郭金玉, 李峥. 心力衰竭患者住院前症状群的研究[J]. 中华护理杂志, 2015,50(3):292-295.
[14]	Lévy S, Maarek M, Coumel P, et al. Characterization of different subsets of atrial fibrillation in general practice in France:the ALFA study. The college of french cardiologists[J]. Circulation, 1999,99(23):3028-3035. DOI URL PMID
[15]	Dorian P, Burk C, Mullin CM, et al. Interpreting changes in quality of life in atrial fibrillation:how much change is meaningful?[J]. Am Heart J, 2013,166(2):381-387. DOI URL
[16]	Dorian P, Paquette M, Newman D, et al. Quality of life improves with treatment in the Canadian trial of atrial fibrillation[J]. Am Heart J, 2002,143(6):984-990. DOI URL PMID
[17]	张世强. 关于数理统计中系统聚类法的讨论[J]. 中国卫生统计, 2005,22(5):286-289.
[18]	Streur M, Ratcliffe SJ, Ball J, et al. Symptom clusters in adults with chronic atrial fibrillation[J]. J Cardiovasc Nurs, 2017,32(3):296-303.
[19]	Streur M, Ratcliffe SJ, Callans D, et al. Atrial fibrillation symptom clusters and associated clinical characteristics and outcomes:a cross-sectional secondary data analysis[J]. Eur J Cardiovasc Nurs, 2018,17(8):707-716. DOI URL PMID
[20]	MacRae CA. Symptoms in atrial fibrillation:why keep score?[J]. Circ Arrhythm Electrophysiol, 2009,2(3):215-217. DOI URL PMID
[21]	Rienstra M, Lubitz SA, Mahida S, et al. Symptoms and functional status of patients with atrial fibrillation:state of the art and future research opportunities[J]. Circulation, 2012,125(23):2933-2943. DOI URL PMID
[22]	Sears SF, Serber ER, Alvarez LG, et al. Understanding atrial symptom reports:objective versus subjective predictors[J]. Pac-ing Clin Electrophysiol, 2005,28(8):801-807.
[23]	Lindgren TG, Fukuoka Y, Rankin SH, et al. Cluster analysis of elderly cardiac patients’ prehospital symptomatology[J]. Nurs Res, 2008,57(1):14-23.
[24]	Carrington MJ, Ball J, Horowitz JD, et al. Navigating the fine line between benefit and risk in chronic atrial fibrillation:rationale and design of the standard versus atrial fibrillation spe-cific management study(SAFETY)[J]. Int J Cardiol, 2013,166(2):359-365. URL PMID
[25]	Siontis KC, Gersh BJ, Killian JM, et al. Typical,atypical,and asymptomatic presentations of new-onset atrial fibrillation in the community:characteristics and prognostic implications[J]. Heart Rhythm, 2016,13(7):1418-1424. URL PMID
[26]	Piccini JP, Simon DN, Steinberg BA, et al. Differences in clinical and functional outcomes of atrial fibrillation in women and men:two-year results from the ORBIT-AF registry[J]. JAMA Cardiol, 2016,1(3):282-291.
[27]	Ball J, Carrington MJ, Wood KA, et al. Women versus men with chronic atrial fibrillation:insights from the Standard versus atrial fibrillation specific management study(SAFETY)[J]. PLoS One, 2013,8(5):e65795. DOI URL PMID
[28]	Barsky AJ, Cleary PD, Barnett MC, et al. The accuracy of symptom reporting by patients complaining of palpitations[J]. Am J Med, 1994,97(3):214-221. DOI URL PMID
[29]	Thompson TS, Barksdale DJ, Sears SF, et al. The effect of anxiety and depression on symptoms attributed to atrial fibrillation[J]. Pacing Clin Electrophysiol, 2014,37(4):439-446.
[30]	Pathak RK, Elliott A, Middeldorp ME, et al. Impact of Cardio respiratory fitness on arrhythmia recurrence in obese individuals with atrial fibrillation[J]. J Am Coll Cardiol, 2015,66(9):985-996. URL PMID
[31]	Pathak RK, Middeldorp ME, Meredith M, et al. Long-term effect of goal-directed weight management in an atrial fibrillation cohort:a long-term follow-up study(LEGACY)[J]. J Am Coll Cardiol, 2015,65(20):2159-2169. URL PMID
[32]	Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation[J]. JAMA, 2004,292(20):2471-2477. DOI URL PMID
[33]	Streur MM, Ratcliffe SJ, Callans DJ, et al. Atrial fibrillation symptom profiles associated with healthcare utilization:a latent class regression analysis[J]. Pacing Clin Electrophysiol, 2018,41(7):741-749. URL PMID
[34]	Santhanakrishnan R, Wang N, Larson MG, et al. Atrial fibrillation begets heart failure and vice versa:temporal associations and differences in preserved versus reduced ejection fraction[J]. Circulation, 2016,133(5):484-492. DOI URL PMID
[35]	严毓勤, 朱雅琴, 周龙女, 等. 不同类型心力衰竭合并心房颤动的临床特点及心脏结构变化[J]. 中国临床保健杂志, 2019,22(2):247-250.
[36]	Grace AA, Narayan SM. Common threads in atrial fibrillation and heart failure[J]. Heart Fail Clin, 2013,9(4):373-383. URL PMID