Syntax积分对非体外循环冠状动脉旁路移植术后早期新发房颤的预测作用研究  

Predictive value of Syntax score for early onset of postoperative primary atrial fibrillation after off-pump coronary artery bypass grafting

作　　者：李一帆[1] 董士勇[1] 肖锋[1] 王进[1] 宋波[1] 李西慧[1] 杨阳[1] 李岩[1] 

机构地区：[1]京北京大学第一医院心脏外科,北100034

出　　处：《解放军医学杂志》2014年第5期416-420,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的 探讨Syntax积分系统在非体外循环冠状动脉旁路移植（OPCAB）术后早期新发房颤预测中的作用。方法 回顾性分析2012年11月－2013年4月在北京大学第一医院接受择期OPCAB治疗的81例冠心病患者的临床资料。计算入选患者术前的Syntax积分，并收集术前、手术相关及术后信息，进行单因素及多因素logistic 回归分析，寻找术后早期新发房颤的独立相关因素。结果 本组患者术前Syntax积分为5.0-58.5（29.5±10.2）分，术后早期新发房颤总发生率为25.9%（21/81）。多因素分析结果显示，术后早期新发房颤的独立危险因素为Syntax积分（RR=1.110，95%CI 1.038-1.188，P=0.002）和监护室停留时间（RR=1.028，95%CI 1.008-1.047，P=0.005），独立保护性因素为远端吻合口数量（RR=0.354， 95%CI 0.137-0.917，P=0.033）。根据Syntax积分分层（≤22分，23-32分，≥33分）后3组间术后早期新发房颤发生率（分别为9.1%、23.1%、39.4%）差异有统计学意义（P=0.031）。ROC曲线分析显示，Syntax积分对术后早期新发房颤具有明显预测价值（AUC=0.704，95%CI 0.579-0.828，P=0.006）。结论 Syntax积分和监护室停留时间是OPCAB术后早期新发房颤的独立危险因素，而远端吻合口数量是其独立保护因素。Syntax积分可预测OPCAB术后早期房颤的发生。Objective To explore the predictive value of Syntax score system for early onset of postoperative primary atrial fibrillation （AF） after off-pump coronary artery bypass grafting （OPCAB）. Methods The clinical data of 81 consecutive patients undergoing OPCAB in Peking University First Hospital from Nov 2012 to Apr 2013 were retrospectively analyzed. The Syntax score before operation was calculated. Patients＇ baseline information, clinical data during and after operation, and information about outcome were collected. Univariate and multivariate logistic regression analyses were used to detect independent relative factors for postoperative newly developed primary AF. Results The Syntax score of the 81 patients before operation was 5.0-58.5 （29.5±10.2）, and the incidence of postoperative primary AF was 25.9% （21/81）. Multivariate analysis showed that the Syntax score （RR=1.110, 95%CI 1.038-1.188, P=0.002） and duration of ICU stay （RR=1.028, 95%CI 1.008-1.047, P=0.005） were the independent risk factors, and the number of distal anastomosis （RR=0.354, 95%CI 0.137-0.917, P=0.033） was the independent protective factor for postoperative primary AF. According to different stratum of Syntax score （≤22, 23-32, and ≥33）, the incidence of primary AF （9.1%, 23.1% and 39.4%, respectively） showed marked difference （P=0.031）. Receiver operator characteristic （ROC） curve analysis showed the Syntax score has a significant predictive value for postoperative primary AF （AUC=0.704, 95%CI 0.579 0.828, P=0.006）. Conclusion Syntax score and duration of ICU stay are independent risk factors for postoperative primary AF, and the number of distal anastomosis is the independent protective factor. Syntax score could well predict the primary AF after OPCAB.

关 键 词：冠状动脉疾病 SYNTAX积分 冠状动脉旁路移植术 非体外循环 术后并发症 心房颤动 

分 类 号：R654.33[医药卫生—外科学]