内皮素-1水平与单纯行主动脉瓣置换术患者术后新发房颤的相关性分析  

Correlation analysis between endothelin-1 level and postoperative new onset atrial fibrillation in patients after isolated aortic valve replacement

作　　者：戴江[1] 王生伟 李进华[1] 刘岳[1] 朱恩军[1] 来永强[1] Dai Jiang;Wang Shengwei;Li Jinhua;Liu Yue;Zhu Enjun;Lai Yongqiang(Structural Heart Surgery Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院结构性心脏病外科中心,100029

出　　处：《中华损伤与修复杂志（电子版）》2022年第4期308-314,共7页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：国家自然科学基金(82170374)。

摘　　要：目的探讨内皮素-1水平与单纯行主动脉瓣置换术患者术后新发房颤的关系。方法回顾性分析2017年6月至2019年6月于首都医科大学附属北京安贞医院结构性心脏病外科中心单纯行主动脉瓣置换术的119例患者的临床资料,根据患者术后是否新发房颤分为术后房颤组(n=28)和无术后房颤组(n=91)。2组患者均于全身麻醉成功后取仰卧位,常规消毒铺巾,作胸部正中切口并劈开胸骨。切开心包并悬吊,肝素化后升主动脉、右心房二阶梯引流管插管建立体外循环,转机、降温,阻断循环,切开主动脉,探查主动脉瓣病变情况,剪除病变主动脉瓣,选择合适大小的人工主动脉瓣(机械瓣或生物瓣)进行置换,全周间断缝合。关闭主动脉切口。复温、排气,开放循环。并行稳定后停止体外循环,拔出动静脉管路。常规止血关胸,结束手术。统计患者术前各项资料中最可能影响术后房颤发生的因素[性别、年龄、体重指数、内皮素-1水平、基础疾病、美国纽约心脏病协会(NYHA)心功能分级、超声心动图指标]、术中资料(术中体外循环时间、主动脉阻断时间)及术后资料[术后机械通气时间、术后住院时间、行开胸止血术例数、使用何种类型人工瓣膜(机械瓣或生物瓣)]。数据比较采用t检验、非参数检验、χ^(2)检验;通过受试者工作特征(ROC)曲线确定内皮素-1预测术后新发房颤的截断值;采用单因素和多因素Logistic回归分析与术后新发房颤相关的危险因素。结果(1)术后房颤组患者的年龄为(53.0±12.1)岁,高于无术后房颤组[(47.1±13.6)岁],术前内皮素-1水平为0.43±0.19,高于无术后房颤组(0.27±0.14),NYHA分级≥3级患者比例为14.3%(4/28),高于无术后房颤组[4.4%(4/91)],左心房直径为(40.6±4.8)mm,大于无术后房颤组[(36.7±5.2)mm],主动脉瓣狭窄患者比例为39.3%(11/28),低于无术后房颤组[60.4%(55/91)],2组比较差异均有统计学意义Objective To investigate the relationship between endothelin-1 level and new onset atrial fibrillation after isolated aortic valve replacement.Methods The clinical data of 119 patients who underwent isolated aortic valve replacement in the Structural Heart Surgery Center,Beijing Anzhen Hospital,Capital Medical University from June 2017 to June 2019 were retrospectively analyzed.According to whether the patients had postoperative new onset atrial fibrillation,they were divided into postoperative atrial fibrillation group(n=28)and non postoperative atrial fibrillation group(n=91).After the successful general anesthesia,the patients in both groups were taken to the supine position,routinely disinfected and covered with towels,a median chest incision was made and the sternum was split.The pericardium was cut and suspended.After heparinization,the ascending aorta and right atrium were intubated with two-step drainage tubes to establish extracorporeal circulation.The circulation was switched,cooled,blocked,the aorta was cut,the pathological condition of the aortic valve was explored,the pathological aortic valve was cut off,and the artificial aortic valve(mechanical valve or biological valve)of appropriate size was selected for replacement,and the whole week was sutured intermittently.After the aortic incision was closed,rewarmed,exhausted,and then the circulation was opened.After parallel stabilization,the cardiopulmonary bypass was stopped and the arteriovenous pipeline was pulled out.Routine hemostasis,chest closure,and the operation was end.The factors most likely to affect the occurrence of postoperative atrial fibrillation including the preoperative data[gender,age,body mass index,endothelin-1 level,basic diseases,New York Heart Association(NYHA)cardiac function classification,echocardiographic indicators],intraoperative data(intraoperative cardiopulmonary bypass time,aortic occlusion time),and postoperative data[postoperative mechanical ventilation time,postoperative hospital stay,number of cases undergoing thor

关 键 词：心房颤动 主动脉瓣 心脏瓣膜 人工 内皮素-1 

分 类 号：R541.75[医药卫生—心血管疾病]