赵士荣 王学 颜燕

[摘要] 目的 探讨心房颤动（以下簡称“房颤”）经股静脉行射频消融术后影响患者恢复的活动时机。 方法 选取2018年11月～2019年9月辽宁省大连市中心医院心内科经股静脉行射频消融术的房颤患者167例作为研究对象，采用随机数字表法将患者分为对照组（83例）与试验组（84例）。对照组采用常规护理方法，试验组采用术后早期床上活动的方法。观察两组患者并发症（穿刺部位出血、尿潴留）发生情况、腰背部舒适状况量表（GCQ）评分、疼痛评分和焦虑评分情况。 结果 两组术后穿刺部位出血发生率、尿潴留发生率比较，差异无统计学意义（P > 0.05）;不同时间、分组患者腰背部疼痛评分、腰背部GCQ评分指标不同，且时间、分组存在交互作用，差异均有统计学意义（P < 0.05）。进一步两两比较，组内比较：对照组术后各时间点腰背部疼痛评分均高于返回病房时，腰背部GCQ评分低于返回病房时，且术后各时间点比较（P < 0.05），观察组术后各时间点腰背部疼痛评分均低于返回病房时，腰背部GCQ评分高于返回病房时，且术后各时间点比较（P < 0.05）;组间比较：试验组术后各时间腰背部GCQ评分高于对照组，腰背部疼痛评分低于对照组，差异有统计学意义（P < 0.05）。对照组术后6 h焦虑自评量表评分高于术前（P < 0.05），试验组焦虑自评量表评分与术前比较，差异无统计学意义（P > 0.05）。术后6 h，试验组焦虑自评量表评分低于对照组，差异有统计学意义（P < 0.05）。 结论 及早活动并不会增加房颤射频消融术后患者并发症的发生率，但可以改善患者腰背部疼痛、舒适度及心理焦虑症状，房颤经股静脉行射频消融治疗患者术后活动时机宜及早进行。

[关键词] 心房颤动;股静脉;射频消融术;活动时机

[中图分类号] R473.5          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0190-04

[Abstract] Objective To investigate the effect of radiofrequency ablation of atrial fibrillation via femoral vein on the recovery time of patients. Methods A total of 167 patients with ATRIAL fibrillation who underwent femoral vein radiofrequency ablation in the Department of Cardiology， Dalian Municipal Central Hospital of Liaoning Province from November 2018 to September 2019 were selected as study subjects. Patients were divided into control group （83 cases） and experimental group （84 cases） by random number table method. Routine nursing was used in the control group， and early postoperative bed activity was used in the experimental group. Complications （bleeding at puncture site， urinary retention）， general comfort questionnaire （GCQ）， pain score and anxiety score were observed in the two groups. Results There was no significant difference between the two groups in the incidence of postoperative hemorrhage and urinary retention （P > 0.05）. Low back pain score and low back GCQ score of patients in different time and groups were different， and there was interaction between time and groups， and the differences were statistically significant （P < 0.05）. Further pair comparison and intra-group comparison： in the control group， the score of lower back pain at each time point after surgery was higher than that when patients returned to the ward， and the GCQ score of lower back was lower than that when patients returned to the ward， and the comparison of each time point after surgery （P < 0.05）. The score of lower back pain in the observation group at all postoperative time points was lower than that when returning to the ward， and the GCQ score of lower back was higher than that when returning to the ward， and the comparison of postoperative time points （P < 0.05）. Comparison between groups： the GCQ score of lower back of the experimental group was higher than that of the control group， and the score of lower back pain was lower than that of the control group， the differences were statistically significant （P < 0.05）. The self-rating anxiety scale score of the control group 6 h after surgery was higher than that before surgery （P < 0.05）， while the self-rating anxiety scale score of the test group was not statistically significant compared with that before surgery （P > 0.05）. 6 h after surgery， the self-rating anxiety scale score of the experimental group was lower than that of the control group， with statistically significant difference （P < 0.05）. Conclusion Early activity does not increase the incidence of complications in patients with AF after RADI of requency ablation， but it can improve the lower back pain， comfort level and psychological anxiety symptoms of patients. Therefore， it is advisable to conduct early postoperative activity in patients with AF treated by radiofrequency ablation through femoral vein.

[Key words] Atrial fibrillation; Femoral vein; Radiofrequency ablation; Activity time

心房颤动（以下简称“房颤”）是临床最常见的有不良预后的心律失常，其发生率随着年龄增长而提高，严重影响患者生活质量并危及生命。目前治疗手段有药物、外科手术和心导管射频消融3种方法，而心导管射频消融术对于药物治疗无效的心律失常患者更具有安全有效的优势[1-3]，心导管射频消融术（radiofrequency catheter ablation，RFCA）是治疗心律失常的主要介入方法，因其创伤小、效果好、恢复快、患者易于接受等优势，普遍应用于临床[4]。作为一种侵入性诊疗操作技术，为防止术后并发症，目前射频消融术后需要长时间卧床，限制躯体活动度，严重影响了患者术后舒适度，增加了不良情绪反应。为提……