接受心房颤动消融术的肥胖患者发生急性疼痛的风险

Risk of Acute Pain in Obese Patients Undergoing Atrial Fibrillation Ablation.

作者信息

Dong Peiyu, Wang Hongbai, Yan Fuxia, Zhang Zhe

机构信息

Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

出版信息

J Pain Res. 2025 May 20;18:2549-2557. doi: 10.2147/JPR.S517820. eCollection 2025.

DOI:10.2147/JPR.S517820

PMID:40417071

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12103171/

Abstract

BACKGROUND

Previous studies have indicated that obesity can lead to an increased pain sensitivity. However, the risk of acute pain in obese patients undergoing atrial fibrillation (AF) ablation remains unclear.

METHODS

This was a case-control study. Clinical data of patients with AF who underwent percutaneous ablation at Fuwai Hospital between January and May 2019 were retrospectively collected. Numeric pain rating scale (NPRS) and Body mass index (BMI) were used to assess severity of intra-procedural pain and pre-procedural obesity, respectively. An intra-procedural NPRS score of 4 or higher indicated the presence of acute pain, and a pre-procedural BMI of 28 or greater was considered indicative of obesity. Multivariable logistic regression analysis was performed to explore the risk of intra-procedural acute pain in obese patients.

RESULTS

A total of 333 eligible patients were divided into two groups based on presence of intra-procedural acute pain (case group: n=102 [30.6%] and control group: n=231 [69.4%]). Compared with control group, patients with intra-procedural acute pain showed higher percentage of obesity (40 [17.4%] vs 28 [27.5%]) and conscious sedation (96 [41.6%] vs 89 [87.3%]), lower percentage of diabetes history (38 [16.5%] vs 10 [9.8%]), and longer duration of procedure (median, 90 vs 110 min). The occurrence rates of acute pain during AF ablation were 41.2% for obese patients and 27.9% for non-obese patients. Obesity was independently associated with an increased risk of intra-procedural acute pain (adjusted odds ratio [OR], 2.29; 95% CI, 1.18-4.43, P = 0.014). Sub-group analysis indicated a stronger risk of intra-procedural acute pain in obese patients under conscious sedation (adjusted OR, 2.48; 95% CI, 1.13-5.42, P = 0.023).

CONCLUSION

Under conscious sedation, obesity is an independent risk factor for intra-procedural acute pain in adult patients undergoing AF ablation.

摘要

背景

既往研究表明肥胖可导致疼痛敏感性增加。然而，肥胖患者接受心房颤动（AF）消融时发生急性疼痛的风险仍不明确。

方法

这是一项病例对照研究。回顾性收集2019年1月至5月在阜外医院接受经皮消融的房颤患者的临床资料。分别采用数字疼痛评分量表（NPRS）和体重指数（BMI）评估术中疼痛严重程度和术前肥胖情况。术中NPRS评分4分及以上表明存在急性疼痛，术前BMI 28及以上被认为提示肥胖。进行多变量逻辑回归分析以探讨肥胖患者术中急性疼痛的风险。

结果

根据术中是否存在急性疼痛，共333例符合条件的患者被分为两组（病例组：n = 102 [30.6%]，对照组：n = 231 [69.4%]）。与对照组相比，术中发生急性疼痛的患者肥胖比例更高（40 [17.4%] 对28 [27.5%]）、清醒镇静比例更高（96 [41.6%] 对89 [87.3%]）、糖尿病史比例更低（38 [16.5%] 对10 [9.8%]）且手术持续时间更长（中位数，90对110分钟）。AF消融术中肥胖患者急性疼痛发生率为41.2%，非肥胖患者为27.9%。肥胖与术中急性疼痛风险增加独立相关（调整优势比[OR]，2.29；95%可信区间[CI]，1.18 - 4.43，P = 0.014）。亚组分析表明，清醒镇静下肥胖患者术中急性疼痛风险更高（调整OR，2.48；95% CI，1.13 - 5.42，P = 0.023）。