ICU非心脏手术患者新发房颤持续时间对临床结局的影响  

Effect of the duration of new-onset atrial fibrillation on the clinical outcomes of the patients undergoing ICU non-cardiac surgery

作　　者：吴春芳 王少艾 林勇军 Wu Chun-fang;Wang Shao-ai;Lin Yong-jun(Department of Geriatrics, Quanzhou First Hospital of Fujian Medical University, Quanzhou 362000, China)

机构地区：[1]泉州第一医院老年病科,福建泉州362000

出　　处：《中国急救医学》2019年第2期130-134,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的评价ICU非心脏手术患者新发房颤(NeOAF)持续时间对临床结局的影响。方法回顾性分析2015年1月1日至2017年12月31日期间在我院ICU治疗的282例非心脏手术伴NeOAF患者的临床资料,包括临床特征、血流动力学指标、干预措施和临床结局等,患者均进行动态心电图监测。根据房颤(AF)持续时间是否超过6h,将患者分为持续发病组(AF组)与恢复窦性心率组(SR组),比较两组患者临床资料,评价AF持续时间对临床结局的影响,采用多因素Logistic回归分析评价NeOAF持续时间与死亡的相关性。计算NeOAF患者的持续发病时间,评价持续发病时间与院内病死率和院内卒中的相关性。结果纳入的282例患者中,97例(34.4%)NeOAF持续时间超过6h,185例(65.6%)NeOAF持续时间少于6h并迅速恢复SR。AF组患者的院内病死率显著高于SR组[36.1%(35/97)vs.20.0%(37/185),χ^2=8.657,P=0.003]。多变量Logistic回归分析显示,NeOAF持续时间超过6h与院内死亡风险提高显著相关(OR=3.153,95%CI1.291~7.678,P=0.013)。Cochran-Armitage趋势检验显示,NeOAF持续时间较长的患者有较高的院内病死率(P=0.042)和缺血性卒中发病率(P=0.040)。结论NeOAF持续发作可使ICU非心脏手术患者预后变差,较长的NeOAF持续时间与较高的院内病死率和院内卒中发病率相关,临床医师应当根据NeOAF患者的临床特点采取积极的治疗措施。Objective To evaluate the effect of the duration of new -onset atrial fibrillation (NeOAF)on the clinical outcome of the patients with ICU non -cardiac surgery.Methods The clinical data of 282 NeOAF patients undergoing non -cardiac surgery in ICU was analyzed retrospectively,including the patient's clinical features,hemodynamic parameters,interventions,and clinical outcomes.The patients were subjected to clinical dynamic electrocardiogram monitoring. According to whether the sinus rhythm (SR)is restored after 6 h of atrial fibrillation,the patients were divided into the AF groups and the SR groups.The clinical data of two groups of patients were compared to evaluate the effect of AF duration on the clinical outcome of patients.Multivariate Logistic regression analysis was used to evaluate the association between NeOAF duration and the patient death.The NeOAF duration to onset in patients with NeOAF was calculated to evaluate the relationship between the NeOAF duration of NeOAF and the incidence of in -hospital mortality and in -hospital stroke.Results Of the 282 patients enrolled,97 (34.4%)had a NeOAF duration of more than 6 hours,and 185 (65.6%)of the patients had a NeOAF duration of less than 6 hours and rapidly restored SR.In -hospital mortality was significantly higher in the AF group than in the SR group [36.1%(35/97)vs.20.0%(37/185), x^2 =8.657,P =0.003 ].Multivariate Logistic regression analysis showed that the duration of NeOAF over 6 h was significantly associated with an increased risk of in -hospital mortality (OR =3.153,95% CI 1.291 -7.678,P =0.013).The Coehran -Armitage trend test showed that patients with longer NeOAF duration had higher in -hospital mortality (P =0.042)and ischemic stroke (P =0.040). Conclusion Sustained NeOAF can worsen the outcome of patients with non -cardiac surgery in ICU, and longer durations of NeOAF are associated with higher in -hospital mortality and incidence of in - hospital stroke.Clinicians should take active treatment measures according to the clinical characteristic

关 键 词：新发房颤(NeOAF) 危重症 临床结局 

分 类 号：R541.75[医药卫生—心血管疾病]