术前心率变异性预测非体外循环下冠状动脉旁路移植术后新发心房颤动的回顾性研究  

Prediction of new atrial fibrillation after off-pump coronary artery bypass grafting based on preoperative heart rate variability:A retrospective study

作　　者：王洋 尹宗涛 姜辉 陶登顺 赵科研 张建 辛芳冉 兰怀 张伟 王辉山 WANG Yang;YIN Zongtao;JIANG Hui;TAO Dengshun;ZHAO Keyan;ZHANG Jian;XIN Fangran;LAN Huai;ZHANG Wei;WANG Huishan(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang,110016,P.R.Chin)

机构地区：[1]北部战区总医院心血管外科,沈阳110016

出　　处：《中国胸心血管外科临床杂志》2023年第1期121-125,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(82070239);辽宁省民生科技计划联合计划项目(2021JH/10300082)。

摘　　要：目的研究非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCAB)术前心率变异性(heart rate variability,HRV)与术后心房颤动(postoperative atrial fibrillation,POAF)之间的关系。方法回顾性分析2020年5月—9月北部战区总医院心血管外科收治的拟行OPCAB的290例患者的临床资料,其中男217例、女73例,年龄36~80岁。根据是否发生POAF将患者分为两组,non-POAF组(208例)和POAF组(82例)。计算术前7 d平均HRV的时域、频域因子数值:窦性心搏间期标准差(standard deviation of all normal-to-normal intervals,SDNN)、相邻正常心动周期差值的均方根、相邻正常心动周期之差>50 ms的个数占整个窦性心搏个数的百分比、低频功率(low frequency power,LF)、高频功率(high frequency power,HF)、LF/HF。结果未发生POAF的患者HRV数值明显低于发生POAF的患者(P<0.05)。两组患者的中位SDNN分别为78.90 ms、91.55 ms。年龄[OR=3.630,95%CI(2.015,6.542),P<0.001]、左心房内径[OR=1.074,95%CI(1.000,1.155),P=0.046]和SDNN[OR=1.017,95%CI(1.002,1.032),P=0.024]与POAF的风险降低显著相关。结论SDNN可能是OPCAB术后POAF的独立预测因子。Objective To study the relationship between preoperative heart rate variability(HRV)and postoperative atrial fibrillation(POAF)after off-pump coronary artery bypass grafting(OPCAB).Methods A retrospective analysis was performed on the clinical data of 290 patients who were admitted to the Department of Cardiovascular Surgery,General Hospital of Northern Theater Command from May to September 2020 and received OPCAB.There were 217 males and 73 females aged 36-80 years.According to the incidence of POAF,the patients were divided into two groups:a non-atrial fibrillation group(208 patients)and an atrial fibrillation group(82 patients).The time domain and frequency domain factors of mean HRV 7 days before operation were calculated:standard deviation of all normal-to-normal intervals(SDNN),root mean square of successive differences,percentage difference between adjacent normal-to-normal intervals that were greater than 50 ms,low frequency power(LF),high frequency power(HF),LF/HF.Results The HRV value of patients without POAF was significantly lower than that of patients with POAF(P<0.05).The median SDNN of the two groups were 78.90 ms and 91.55 ms,respectively.Age(OR=3.630,95%CI 2.015-6.542,P<0.001),left atrial diameter(OR=1.074,95%CI 1.000-1.155,P=0.046),and SDNN(OR=1.017,95%CI 1.002-1.032,P=0.024)were independently associated with the risk of POPAF after OPCAB.Conclusion SDNN may be an independent predictor of POAF after OPCAB.

关 键 词：心率变异性 非体外循环下冠状动脉旁路移植术 术后心房颤动 

分 类 号：R654.2[医药卫生—外科学] R541.75[医药卫生—临床医学]