高龄冠心病合并糖尿病患者行冠状动脉旁路移植围术期新发心房颤动的危险因素分析  

Risk factors for perioperative atrial fibrillation in elderly patients with coronary heart disease and diabetes mellitus undergoing coronary artery bypass grafting

作　　者：韩博[1] 王生伟 李继勇[1] 于建波[1] 任长伟[1] 郭鸿昌 来永强[1] HAN Bo;WANG ShengWei;LI Jiyong;YU Jianbo;REN Changwei;GUO Hongchang;LAI Yongqiang(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2022年第2期158-162,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:高龄冠心病合并糖尿病患者行冠状动脉旁路移植(CABG)围术期新发心房颤动的危险因素分析目前尚不明确,因此,本研究旨在探讨这些患者术后新发心房颤动的危险因素。方法:本研究回顾性分析了2017年至2019年我科行CABG术且合并糖尿病的高龄(>70岁)患者68例,将术后持续超过5min或需要抗心律失常或心电复律治疗的心房颤动定义为术后新发心房颤动。结果:在接受CABG术且合并糖尿病的高龄患者中以男性患者居多,为51例75%,平均年龄为(76.2±3.4岁),具有吸烟史的患者为29(42.6%)例,6(8.8%)例患者在手术前进行过冠状动脉支架治疗;术后新发心房颤动患者为23例(33.8%)。经过多因素回归分析,并经过性别、年龄、BMI校正后发现,只有LAD(OR=3.04,95%CI:1.12~5.84,P=0.04)、心功能分级(OR=1.13,95%CI:1.03~1.24,P=0.01)和吸烟史(OR=1.13,95%CI:1.03~1.24,P=0.01)与这部分患者术后新发心房颤动的发生呈独立相关。此外,我们对左心房直径预测术后新发心房颤动的截断值进行了受试者工作特征曲线分析,曲线下面积为0.74,95%CI:0.58~0.89;此外,当LAD为42mm时是这部分患者术后新发心房颤动发生危险因素。结论:在进行CABG术的高龄且合并糖尿病患者中,LAD、术前心功能和吸烟史是这部分患者术后新发心房颤动发生的独立危险因素。Objective: Toinvestigate the risk factors of new onset atrial fibrillation in elderly patients with coronary heart disease and diabetes mellitus undergoing coronary artery bypass grafting(CABG).Methods:68 elderly(> 70 years old)patients with CABG and diabetes mellitus from 2017 to 2019 were retrospectively analyzed. Atrial fibrillation lasting more than 5 minutes or requiring antiarrhythmic or cardioversion therapy was defined as new AF. Results: among the elderly patients with CABG and diabetes mellitus, 51 cases(75%) were male patients, with an average age of(76.2 ± 3.4)years old. 29(42.6%)patients had smoking history. In addition, 6(8.8%)patients had undergone coronary artery stenting before surgery;23 patients(33.8%) had new onset atrial fibrillation. After multivariate regression analysis and adjusted for gender, age and body mass index, only left atrial diameter(OR =3.04,95% CI :1.12-5.84,P =0.04), cardiac function classification(OR =1.13,95% CI :1.03-1.24,P =0.01)and smoking history(OR=1.13,95% CI:1.03-1.24,P =0.01)were independently associated with the occurrence of new AF in these patients. In addition, we analyzed the cut-off value of left atrial diameter in predicting postoperative new onset atrial fibrillation, the area under the curve was 0.74, 95% CI:0.58-0.89;in addition, when the left atrial diameter was 42 mm, it was an independent risk factor for the occurrence of postoperative new atrial fibrillation in these patients. Conclusions: Left atrial diameter, preoperative cardiac function and smoking history are independent risk factors for the occurrence of new AF in elderly patients with diabetes mellitus undergoing CABG.

关 键 词：冠状动脉旁路移植术 高龄 糖尿病 术后新发心房颤动 

分 类 号：R54[医药卫生—心血管疾病]