全麻心房颤动消融术后呼吸道炎症反应特点及危险因素分析  

Characteristics and risk factors of airway inflammatory complications after general anesthesia atrial fibrillation ablation

作　　者：谭明 孙晓燕 张艺民 商丽华 刘建国 Tan Ming;Sun Xiaoyan;Zhang Yimin;Shang Lihua;Liu Jianguo(Second Ward,Department of Cardiology,Beijing Huaxin Hospital,the First Hospital of Tsinghua University,Beijing,100016,China;不详)

机构地区：[1]北京华信医院清华大学第一附属医院心脏中心二病房,北京100016 [2]北京华信医院清华大学第一附属医院心脏中心导管室,北京100016

出　　处：《中国循证心血管医学杂志》2021年第12期1502-1506,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨全麻心房颤动(房颤)消融术后咳嗽、咳痰、伴或不伴发热等呼吸道炎症反应情况的临床特点和相关危险因素分析。方法单中心回顾性研究2019年1月至2020年6月行全麻房颤消融患者90例,根据本次住院期间病程记录确定术后发生咳嗽、咳痰等呼吸道炎症反应情况。分析其发生特点,记录患者一般基线资料和手术情况。通过Logistic回归分析呼吸道炎症反应发生的危险因素。结果术后确诊呼吸道炎症反应14例,发生率15.6%。呼吸道炎症反应表现为术后3~12 h出现咳嗽、咳痰、发热,白细胞计数、中性粒细胞比例、C反应蛋白(CRP)显著升高,淋巴细胞比例、血红蛋白、血小板明显降低。其中,胸片或者胸部计算机断层扫描(CT)明确细菌性肺炎4例(4.4%),痰培养明确两例革兰阳性球菌(金黄色葡萄球菌、溶血性葡萄球菌)肺炎感染较重,另两例痰培养未发现致病菌。青霉素+酶抑制剂与三代头孢+酶抑制剂为主要抗生素,平均使用6 d,最长26 d。多因素回归分析呼吸道炎症反应的危险因素,持续性房颤发生术后呼吸道炎症反应风险显著增高(OR=4.067,95%CI:1.237~13.370,P=0.021),左房前后径扩大(LA>45 mm)同样增加术后呼吸道炎症反应风险(OR=4.529,95%CI:1.169~17.547,P=0.029)。结论全麻房颤消融术后呼吸道炎症反应发生率与持续性房颤及左房增大相关,呼吸道炎症反应增加住院时间及治疗费用,研究预防呼吸道炎症反应方法有重要意义。Objective To investigate the clinical characteristics and related risk factors of patients with respiratory inflammatory response such as cough and expectoration,with or without fever after ablation of AF under general anesthesia.Methods A single-centre retrospective study of 90 patients who underwent AF ablation under general anaesthesia from January 2019 to June 2020 was conducted to determine the occurrence of postoperative respiratory inflammatory reactions such as cough and expectoration based on the course records during this hospitalization.The characteristics of their occurrence were analyzed,and the patients'general baseline data and surgical conditions were recorded.Risk factors for the occurrence of respiratory inflammatory responses were analyzed by logistic regression.Results The respiratory inflammatory response was confirmed postoperatively in 14 patients,with an incidence of 15.6%.The respiratory inflammatory response manifested as cough,expectoration,and fever from 3 to 12 hours after surgery,with significant increases in white blood cell count,neutrophil proportion,C-reactive protein(CRP),and significant decreases in lymphocyte proportion,haemoglobin,and platelets.Among them,four cases(4.4%)had definite bacterial pneumonia on chest radiograph or chest computed tomography(CT),two cases had definite gram-positive cocci(Staphylococcus aureus,Staphylococcus haemolyticus)pneumonia infection by sputum culture,while in the other two cases,no pathogenic bacteria were found by sputum culture.Penicillin+enzyme inhibitors with three-generation Cefalexin+enzyme inhibitors were the main antibiotics used for an average of 6 days and a maximum of 26 days.On multivariate regression analysis of risk factors for the development of a postoperative respiratory inflammatory response,persistent AF was associated with a significantly higher risk(OR=4.067,95%CI:1.237~13.370,P=0.021),and enlargement of the left atrial anteroposterior diameter(LA>45 mm)similarly increased the risk of a postoperative respiratory inflammat

关 键 词：全麻 心房颤动 导管消融 肺炎 

分 类 号：R541.75[医药卫生—心血管疾病]