摘要
目的：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（Atrial fibrillation ，AF）消融的急性疼痛风险尚不清楚。
方法：回顾性收集2019年1 - 5月在阜外医院行经皮消融术的AF患者的临床资料。采用数值疼 痛评定量表（Numeric pain rating scale ，NPRS）和身体质量指数（Body mass index ，BMI）分别评估术中疼痛和术前肥胖的严重程度。术NPRS评分4或更高表明存在急性疼痛，术前BMI ≥28或更高被认为是肥胖的迹象。采用多因素 logistic 回归分析探讨术中急性疼痛的风险。
结果：共纳入333例患者，根据术中是否发生急性疼痛分为急性疼痛组102例（30.6%）和对照 组231例（69.4%）。与对照组相比，急性疼痛组患者肥胖（40例[17.4%]vs 28例[27.5%]）和 清醒镇静（96例[41.6%]vs 89例[87.3%]）的比例较高，糖尿病史的比例较低（38例[16.5%]vs 10例[9.8%]），手术持续时间较长（中位数，90 min vs 110 min）。肥胖与术中急性疼痛风险增 加独立相关(校正后的比值比[OR]， 2.29；95%ci, 1.18-4.43, p =0.014)。亚组分析显示，清醒镇 静下肥胖患者发生急性疼痛的风险较高(校正OR， 2.48；95%ci, 1.13-5.42, p =0.023)。
结论：肥胖是经皮AF消融成年患者术中急性疼痛的独立危险因素。

Abstract:
Purpose: Previous studies have indicated that obesity can lead to a increased pain sensitivity. However, the risk of acute pain in obese patients undergoing atrial fibrillation (AF) ablation remains unclear.
Methods: 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.
Results: A total of 333 eligible patients were divided into two groups based on presence of intra-procedural acute pain (acute pain group: n=102 [30.6%] and control group: n=231 [69.4%]). Compared with control group, patients with 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). 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 acute pain in obese patients under conscious sedation (adjusted OR, 2.48; 95%CI, 1.13-5.42, P=0.023).
Conclusion: Obesity is an independent risk factor for intra-procedural acute pain in adult patients undergoing percutaneous AF ablation.