老年冠心病患者体外循环冠脉旁路移植术后新发房颤的危险因素分析  

Risk factors of postoperative atrial fibrillation after isolated on-pump coronary artery bypass grafting in elderly patients with coronary heart disease

作　　者：马玉健[1] 罗文琦[1] 王子[1] 甄文俊[1] 欧阳小康[1] 王怀斌[1] Ma Yujian;Luo Wenqi;Wang Zi;Zhen Wenjun;Ouyang Xiaokang;Wang Huaibin(Department of cardiovascular surgery,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)

机构地区：[1]北京医院国家老年医学中心心血管外科,北京100730

出　　处：《中国体外循环杂志》2018年第4期221-225,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨老年冠心病患者行单纯体外循环冠脉旁路移植(ON-CAB)术后新发心房颤动(POAF)的相关危险因素,为预防和治疗POAF提供一定的依据。方法回顾性分析222例≥65岁的老年冠心病患者行单纯ON-CAB的临床资料,根据是否发生POAF分为房颤组(AF)和非房颤组(Non-AF),分析导致老年冠心病患者行单纯ON-CAB术后POAF的危险因素,并探讨其独立危险因素。结果老年冠心病患者单纯ON-CAB术后AF的发生率为26.58%(59/222)。AF组与Non-AF组比较,年龄、性别、高血压病史、糖尿病史、吸烟史、心梗病史、冠脉病变情况、体外循环时间、主动脉阻断时间、术后用血量、呼吸机辅助时间、ICU滞留时间等无显著性差异(P>0.05);术前空腹血糖水平、左房前后径、术后最高血肌酐差异具有统计学意义(P<0.05)。二元Logistic回归分析结果显示,术前空腹血糖水平和左房前后径是老年冠心病患者ON-CAB术后AF的独立危险因素(OR=0.777、1.098,P<0.05)。结论老年冠心病患者行单纯ON-CAB术后AF受多种危险因素影响,其中术前空腹血糖水平和左房前后径是POAF的独立危险因素。Objective To investigate risk factors of postoperative atrial fibrillation（ POAF） in elderly patients with coronary heart disease after isolated on-pump coronary artery bypass grafting（ ON-CAB） in order to provide basis for the prevention and treatment of POAF after ON-CAB. Methods A total of 222 elderly patients with coronary heart disease accepted ON-CAB in our department from November 2013 to October 2016. The patients were divided into AF group and Non-AF group according to the occurrence of POAF. General information and clinical data of the patients were retrospectively analyzed. Logistic regression analysis was used to establish independent clinical risk factors for POAF after isolated ON-CAB in elderly patiets with coronary heart disease. Results The incidence of POAF after ON-CAB was 26.58% in elderly patients with coronary heart disease. There were no statistical differences in age,gender,history of diabetes,history of myocardial infarction,smoking,number of coronary artery lesions,cardiopulmonary bypass time,aortic cross clamping time,amount of drainage and transfusion,duration of ventilation time,and length of ICU stay between the two groups（ P 〉0.05）. Blood sugar,left atrial diameter and the highest level of serum creatinine after operation were higher in AF group than those in Non-AF group（ P 〈0.05）. Logistic regression analysis showed that blood sugar before operation and left atrial diameter were independent risk factors for POAF after isolated ON-CAB in elderly patients with coronary heart disease（ OR = 0.777、1.098,respectively,P 〈0.05）. Conclusion Occurrence of AF after isolated ON-CAB in elderly patients with coronary heart disease was affected by many risk factors. Among those factors,blood sugar before operation and left atrial diameter were independent risk factors of POAF.

关 键 词：体外循环 冠状动脉旁路移植术 心房颤动 老年人 危险因素 

分 类 号：R654.2[医药卫生—外科学]