非体外循环冠状动脉旁路移植术后新发心房颤动预后因素分析  

Prognostic Factors Analysis for New-onset Atrial Fibrillation After Off-pump Coronary Artery Bypass Grafting

作　　者：韦亚林[1] 陈福芳 陈文胜[1] 关新强[1] 张燕春[1] 毛勇[1] 周亚雄[1] 罗伟[1] 吴向阳[1] Wei Yalin;Chen Fufang;Chen Wensheng(Department of Cardiac Surgery,Lanzhou University Second Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院心脏外科

出　　处：《中国微创外科杂志》2019年第10期865-869,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：甘肃省卫生健康委员会基本科研项目(GSWST2012-02);兰州大学第二医院院内博士科研基金项目(ynbskyjj2015-2-6)

摘　　要：目的探讨非体外循环冠状动脉旁路移植(off-pump coronary artery bypass grafting,OPCAB)术后新发心房颤动(房颤)的预后因素。方法回顾性分析2012年1月~2018年12月我院234例OPCAB临床资料,术后出现新发房颤36例(房颤组),未出现房颤198例(非房颤组),通过单因素和多因素logistic回归分析术后新发房颤的预后因素。结果单因素分析结果显示,术后新发房颤可能的预后因素有年龄、高血压、频发房性期前收缩(房早)或房性心动过速(房速)、合并心脏其他畸形、收缩压,术前肌酐、尿酸、射血分数(EF)、左房前后径和肺动脉压力,术后血钾和肌酸激酶同工酶(CK-MB)(P<0.05)。多因素logistic回归分析显示术前合并高血压(OR=6.109,P=0.019),频发房早或房速(OR=9.915,P=0.017),肌酐增高(男性>106μmol/L,女性>97μmol/L)(OR=18.798,P=0.019),左房前后径增大(男性>38.7 mm,女性>36.8 mm)(OR=17.894,P=0.000)和EF减低(EF<55%)(OR=11.505,P=0.004)是OPCAB术后新发房颤的预后因素。结论术前合并高血压、频发房早或房速、肌酐增高、左房增大和EF减低是OPCAB术后新发房颤的预后因素。Objective To investigate prognostic factors of new-onset atrial fibrillation(AF)after off-pump coronary artery bypass grafting(OPCAB).Methods There were 36 patients with new-onset AF(AF group)and 198 patients with non-AF(non-AF group)who underwent OPCAB in our hospital from January 2012 to December 2018.The diagnostic factors of new-onset AF after OPCAB were analyzed by univariate and multinariate logistic regression analysis.Results The univariate factor analysis showed that prognostic factors associated with postoperative new-onset atrial fibrillation were age,hypertension,frequent premature atrial beating and atrial tachycardia,other cardiac malformations,systolic blood pressure,preoperative creatinine,uric acid,ejection fraction(EF),left atrial anteroposterior diameter,and pulmonary artery pressure,postoperative serum potassium and creatine kinase-MB(CK-MB)(P<0.05).Multinariate analysis showed that hypertension(OR=6.109,P=0.019),frequent atrial premature beating or atrial tachycardia(OR=9.915,P=0.017),elevated levels of preoperative creatinine(for male more than 106μmol/L,and for female more than 97μmol/L)(OR=18.798,P=0.019),preoperative left atrial anteroposterior diameter dilation(for male more than 38.7 mm,and for female more than 36.8 mm)(OR=17.894,P=0.000)and decreased preoperative EF(EF<55%)(OR=11.505,P=0.004)were suspected prognostic factors for predicting new-onset AF after OPCAB.Conclusion Preoperative hypertension,frequent atrial premature beating and atrial tachycardia,increased creatinine,left atrial enlargement,and EF reduction were prognostic factors for new-onset AF after OPCAB.

关 键 词：非体外循环冠状动脉旁路移植术 新发房颤 预后因素 

分 类 号：R54[医药卫生—心血管疾病]