心脏手术中左心耳闭合在预防术后心房颤动和脑血管意外中的作用  

Left atrial appendage closure during cardiac surgery may prevent postoperative atrial fibrillation and atrial fibrillation-related cerebrovascular accident

作　　者：艾克拜尔·安尼瓦尔 艾斯卡尔·沙比提[1] 阿布都乃比·麦麦提艾力[1] 木拉提·阿布都热合曼[1] 李俊红[1] 

机构地区：[1]新疆医科大学第一附属医院心脏外科一科,乌鲁木齐830054

出　　处：《中华心律失常学杂志》2016年第2期149-153,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探究在心脏手术中常规左心耳闭合是否能减少术后心房颤动（房颤）及房颤相关的脑血管意外风险。方法回顾性分析2012年1月至2014年6月在新疆医科大学第一附属医院接受心脏瓣膜置换的486例成年患者术后第1、3、6、12个月及其后每年的门诊及电话随访资料，其中男203例，女283例，平均年龄（46．2±10．3）岁。根据心脏瓣膜置换术中同期是否闭合左心耳分为2组：闭合组（n=147）和非闭合组（n=339），观察患者术后房颤及缺血性脑卒中的发生率，并通过Logistic回归分析评估缺血性脑卒中发生的危险因素。结果术后随访期间共15例患者发生缺血性脑卒中，发生率为3．1％。闭合组房颤伴缺血性脑卒中发生率低于非闭合组（0．7％对2．9％,χ2=6．516，P=0．011）。Logistic多因素回归分析结果显示，年龄〉60岁（OR=1．059，95％CI：1．022～1．098，P=0．002）是缺血性脑卒中的危险因素。左心耳未闭合（OR=1．76，95％CI：1．03～3．00，P=0．026）和年龄〉60岁（OR=3．61，95％CI：1．83～7．13，P=0．031）是术后房颤的危险因素。闭合组和未闭合组的亚层分析结果显示，左心耳闭合是预防房颤患者术后缺血性脑卒中的保护因素（OR=0．34，95％CI：0．16～0．81，P=0．017），左心耳未闭合是术后房颤及脑卒中的危险因素（OR=8．05，95％CI：1．97～32．89，P=0．001）。结论虽然房颤是心脏术后常见的并发症，常规闭合左心耳可以使术后房颤和脑血管意外的发生率明显降低。Objective The aim of the study was to determine whether routine left atrial appendage （LAA） closure in cardiac surgery would reduce tile risk of postoperative atrial fibrillation and postoperative at- rial fibrillation-related cerebrovascular accident. Methods The clinical data of 486 adult patients who under- went cardiac valve replacement from January 2012 to June 2014 in the First Affiliated Hospital of Xinjiang Med- ical University were retrospectively analyzed.There were 203 male and 283 female patients ,with a mean age of （46. 2± 10. 3 ）years.The patients were divided into two groups according to whether the left atrial appendage was closed during operation： LAA closure group（ n = 147）and non-LAA closure group（ n = 339）.Postoperative cere- bral ischemic stroke and the risk factors for cerebral ischemic stroke were assessed. Multivariate analysis was performed using logistic regression analysis. Results Postoperative cerebral isehemic stroke occurred in 15 pa- tients（ 3.1% ）.The incidence of fibrillation-related cerebral ischemic stroke in LAA closure group was signifi- candy lower than that in non-LAA closure group（ 0. 7% vs. 2. 9% ,X2 = 6. 516, P = 0. 011 ）. Logistic regression a- nalysis showed that aged more than 60 years was a significant risk factor for postoperative cerebral ischemic stroke （ OR = 1. 059,95% CI： 1. 022-1. 098, P = 0. 002） while non-LAA closure （ OR = 1.76,95% CI： 1.03- 3.00, P = 0. 026 ） and age more than 60 years （ OR = 3.61,95 % CI： 1.83- 7.13, P = 0.031 ） being the in- dependent risk factors for postoperative fibrillation.The subgroup analysis showed that for atrial fibrillation patients LAA closure was a strong protective factor （ OR = 0. 34,95 % CI： 0. 16- 0. 81, P = 0. 017 ）, but non- LAA closure was a significant risk factor（ OR= 8.05,95%CI： 1.97-32. 89,P= 0. 001 ）.Conclusion Posto- perative atrial fibrillation remains a common complication of cardiac surgery.There is a significant decrease in the incidence of postoperati

关 键 词：心房颤动 脑卒中 左心耳闭合 脑血管并发症 

分 类 号：R654.2[医药卫生—外科学]