上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (9): 1303-1310.doi: 10.3969/j.issn.1674-8115.2022.09.017

• 论著 · 临床研究 • 上一篇    

3~6岁先天性心脏病患儿术后心脏康复水平及其相关因素的Rasch分析

罗雯懿1,2(), 陈琳3, 袁理3, 倪平3, 蔡小满3, 章雅青2()   

  1. 1.上海交通大学医学院附属上海儿童医学中心护理部，上海 200127
    2.上海交通大学护理学院，上海 200025
    3.上海交通大学医学院附属上海儿童医学中心心胸外科，上海 200127
  • 收稿日期:2022-05-04 接受日期:2022-08-18 出版日期:2022-09-07 发布日期:2022-09-07
  • 通讯作者: 章雅青 E-mail:luowenyi@scmc.com.cn;zhangyqf@163.com
  • 作者简介:罗雯懿（1985—），女，副主任护师，博士生；电子信箱： luowenyi@scmc.com.cn。
  • 基金资助:
    上海市卫生健康委员会科研课题(20194Y0479);上海交通大学医学院护理学科建设项目

Rasch analysis of postoperative cardiac rehabilitation and related factors in 3-6-year-old children with congenital heart disease

LUO Wenyi1,2(), CHEN Lin3, YUAN Li3, NI Ping3, CAI Xiaoman3, ZHANG Yaqing2()   

  1. 1.Nursing Department, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    2.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China
    3.Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Received:2022-05-04 Accepted:2022-08-18 Online:2022-09-07 Published:2022-09-07
  • Contact: ZHANG Yaqing E-mail:luowenyi@scmc.com.cn;zhangyqf@163.com
  • Supported by:
    Scientific Research Project of Shanghai Municipal Health Commission(20194Y0479);Nursing Development Program of Shanghai Jiao Tong University School of Medicine

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摘要：

目的·借助Rasch模型对3~6岁先天性心脏病（先心病）患儿手术后第1年是否发生心力衰竭（心衰）及相关的功能损害条目进行分析。方法·纳入2021年2月—8月至上海交通大学医学院附属上海儿童医学中心随访就诊的先心病术后1年内的3~6岁儿童，收集患儿一般资料、家长填写的先心病术后心脏康复评价表以及心衰诊断结果。采用Winsteps 3.72.3软件进行Rasch模型分析，将患儿术后功能损害程度和心脏康复评价条目的难度转化为同一评价体系（Logit）进行比较。多因素Logistic回归分析与心衰结局相关的条目。结果·共纳入340例先心病术后患儿，患儿平均年龄为（4.48±1.05）岁，平均随访时间为术后（8.33±2.79）个月。通过Rasch模型分析，先心病术后心脏康复评价表条目的总体难度适中（Logit值为0），适合研究人群。340例患儿术后总体功能损害程度Logit值为－2.35±0.87，表明手术后患儿整体康复水平较好；其中有24例患儿（占7.1%）出现心衰，且心衰患儿总体功能损害程度显著高于非心衰患儿（ P=0.000）。通过将患儿术后个体功能损害程度与心脏康复评价条目的难度水平转化为同一评价体系后，发现心衰患儿在“b1302食欲”（ P=0.014）、“b152情绪功能”（ P=0.014）、“b435免疫系统功能”（ P=0.000）、“b455运动耐受功能”（ P=0.014）、“b530体重维持功能”（ P=0.000）、“b560维持生长功能”（ P=0.000）、“d160集中注意力”（ P=0.001）、“e450卫生专业人员的个人态度”（ P=0.001）及“e580 卫生的服务、体制和政策”（ P=0.000）9个条目未达标的比例显著高于非心衰患儿。多因素Logistic回归分析结果发现，“e580卫生的服务、体制和政策”是与心衰相关的条目（ OR=13.250，95% CI 4.905~35.795）。结论·多数先心病术后1年内随访患儿的康复水平较好，但仍有少数患儿出现心衰；针对患儿的心理行为、心肺功能、营养状况和医疗环境制定相应的卫生服务策略，可能有助于改善患儿术后心脏康复水平，减少心衰发生。

关键词: 先天性心脏病, 儿童, 心脏康复, 心力衰竭

Abstract:

Objective ·To analyze the occurrence of heart failure (HF) and related functional impairment items in 3?6-year-old children with congenital heart disease (CHD) in the first year after operation by using the Rasch model. Methods ·The children aged 3?6 years old who were followed up at Shanghai Children 's Medical Center, Shanghai Jiao Tong University School of Medicine, from February to August 2021 were included. The general information of children, the evaluation of International Classification of Functioning, Disability, and Health for Children and Youth core set for children with congenital heart disease after surgery (ICF-CY-CHDS) filled by their parents and the diagnosis of HF were collected. The analysis with Rasch model was carried out by using Winsteps 3.72.3 software, and the degree of postoperative functional impairment and the difficulty of the items of the ICF-CY-CHDS were transformed into the same evaluation system (Logit value) for comparison. Multivariate Logistic regression was used to analyze the items related to HF. Results ·A total of 340 CHD children after surgery were included. The average age of the children was (4.48±1.05) years old and their average follow-up time was (8.33±2.79) months after CHD surgery. According to the analysis of Rasch model, the overall difficulty of the items of the ICF-CY-CHDS was moderate (the Logit value was 0), which was suitable for the study population. The Logit value of the overall functional impairment of 340 children was -2.35±0.87, indicating that the overall rehabilitation level of the children after CHD surgery in the first year was good; Among them, 24 children (7.1%) had HF, and the overall functional impairment of the children with HF was significantly more serious than that of the children without HF ( P=0.000). After transforming the degree of postoperative functional impairment and the difficulty of the items of the ICF-CY-CHDS into the same evaluation system, it was found that the proportions of the children failing to reach the standards in 9 items were higher in the HF children than those in the non-HF ones. The 9 items were “b1302 appetite” ( P=0.014), “b152 emotional functions” ( P=0.014), “b435 immunological system functions” ( P=0.000), “b455 exercise tolerance functions” ( P=0.014), “b530 weight maintenance functions” ( P=0.000), “b560 growth maintenance function” ( P=0.000), “d160 focusing attention” ( P=0.001), “e450 individual attitudes of health professionals” ( P=0.001), and “e580 health services, systems and policies” ( P=0.000). The results of multivariate Logistic regression demonstrated that “e580 health services, systems and policies” was the item related to HF ( OR=13.250, 95% CI 4.905?35.795). Conclusion ·The overall rehabilitation level of the children with CHD in the first year after surgery is good, but there are still a few children with HF. Making corresponding health service strategies about children 's psychological behavior, cardiopulmonary function, nutritional status, and medical environment may be helpful to improve children 's postoperative cardiac rehabilitation level and reduce the occurrence of HF.

Key words: congenital heart disease, children, cardiac rehabilitation, heart failure

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