术前左心房内径预测冠状动脉旁路移植术后新发房颤的价值  

Predictive value of preoperative left atrial diameter in the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting

作　　者：高铭鑫[1] 范康钧 于文渊[1] 柳弘历 丁晓航 陈良 李海洋[1] 于洋[1] Gao Mingxin;Fan Kangjun;Yu Wenyuan;Liu Hongli;Ding Xiaohang;Chen Liang;Li Haiyang;Yu Yang(Department of Cardiac Surgery,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心脏外科,100029

出　　处：《中华胸心血管外科杂志》2022年第12期751-756,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金面上项目(81770343);首都卫生发展科研专项项目(2020-1-2061);北京市自然科学基金青年项目(7214222)。

摘　　要：目的探讨术前左心房内径预测冠状动脉旁路移植术(CABG)术后新发房颤(POAF)的价值,分析术前左心房内径的相关影响因素。方法前瞻性纳入2020年1月~2020年12月期间在首都医科大学附属北京安贞医院拟行CABG治疗冠心病的患者113例。术前均行冠状动脉造影、超声心动图和实验室检查。根据入选及排除标准,最终纳入90例CABG患者,其中男71例,女19例;年龄42~75岁,平均(62±8)岁。统计术中旁路移植血管数和右冠状动脉血运重建情况,术后通过心电监测和心电图检查确诊3天内POAF发生。根据术后是否发生POAF分为POAF组和无POAF组比较两组术前基线资料、实验室检查和围手术期并发症等指标。结果全组无死亡,POAF 25例(27.8%)。POAF组患者的术前左心房内径[40(36,43)mm对35(33,37)mm,P=0.00]、术前高密度脂蛋白[1.08(0.89,1.25)mmol/L对0.95(0.83,1.08)mmol/L,P=0.03]、围手术期肌钙蛋白I[4.76(0.87,13.60)ng/ml对1.48(0.56,4.52)ng/ml,P=0.04]明显高于无POAF组,差异有统计学意义。POAF组患者CABG术后发生卒中[4(16%)对0(0),P=0.01]、住ICU时间[67(24,96)h对22(19,41)h,P=0.00]和住院时间[21(19,24)天对16(14,24)天,P=0.05]明显多于无POAF组,差异有统计学意义。两组围手术期全因病死率、心肌梗死发生率和肺部感染差异无统计学意义(P>0.05)。单因素、多因素二元logistic回归分析结果均显示,左心房内径与POAF发生显著相关(P<0.001)。ROC曲线分析结果显示,术前左心房内径≥40 mm是预测POAF发生的界值(AUC=0.82,敏感度52%,特异100%,P<0.001)。线性回归分析结果显示,术前左心房内径与术前超敏C反应蛋白显著正相关(B=0.24,95%CI:0.00~0.26,P=0.043)。结论CABG后POAF患者的脑血管并发症发生比例明显增加。术前左心房内径还与POAF发生显著相关,可有效预测POAF,左心房内径≥40 mm是预测POAF发生的界值。系统性炎症反应还与术前左心房内径密切相关。Objective To investigate the predictive value of preoperative left atrial diameter in postoperative atrial fibrillation(POAF)after coronary artery bypass grafting(CABG)in patients with coronary artery disease(CAD)and its influencing factors.Methods This study was a prospective observational study.A total of 113 patients with CABG surgery were enrolled in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2020 to December 2020.Preoperative coronary angiography,echocardiography and blood test were finished.The number of graft vessel was counted during the operation.The occurrence of POAF was confirmed by electrocardiogram or electrocardiograph monitoring after surgery.The preoperative baseline data,blood test,perioperative complications and other indicators of patients with or without POAF were compared.Results According to the inclusion criteria and exclusion criteria,90 patients undergoing CABG were enrolled in the study[71 males and 19 females,aged from 42 to 75,mean age(62±8)years old].The incidence of POAF was 27.8%(25 cases).The left atrial diameter[40(36-43)mm vs.35(33-37)mm,P=0.00]and troponin I[4.76(0.87-13.60)ng/ml vs.1.48(0.56-4.52)ng/ml,P=0.04]in patients with POAF were significantly higher than that in patients without POAF.Compared to patients without POAF,POAF significantly increased the incidence of stroke[4(16%)vs.0(0),P=0.01],ICU stay[67(24-96)days vs.22(19-41)days,P=0.00]and hospital stay[21(19-24)days vs.16(14-24)days,P=0.05].Binary logistic regression showed that left atrial diameter was significantly correlated with the occurrence of POAF(OR=1.9,95%CI:1.39-2.79,P<0.001).ROC curve analysis showed that 40 mm of left atrial diameter was a predictor of POAF(AUC=0.82,sensitivity 52%,specificity 100%,P<0.001).Linear regression analysis showed that left atrial diameter was significantly positively correlated with hypersensitive C-reactive protein(Beta=0.24,95%CI:0.00-0.26,P=0.043).Conclusion POAF significantly increased the incidence of stroke after CABG.Preoperative left

关 键 词：冠状动脉旁路移植术 术后新发房颤 术前左心房内径 超敏C反应蛋白 

分 类 号：R654.2[医药卫生—外科学]