术前糖化血红蛋白控制对心脏外科手术同期Cox-Maze,Ⅳ房颤消融术的影响  

Effect of pre-ablation glycated hemoglobin control on outcomes in atrial fibrillation patients with diabetes mellitus following cardiac surgery combined Cox-Maze Ⅳ procedure

作　　者：王天光 华琨[1] 李英健 张晋伟[1] 周明阳[1] 杨秀滨 Wang Tianguang;Hua Kun;Li Yingjian;Zhang Jinwei;Zhou Mingyang;Yang Xiubin(Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Vessel Disease,Beijing 100029,China;Department of Cardiovascular Surgery,Second Affiliated Hospital of Hainan Medical College,Haikou 570311,China)

机构地区：[1]首都医科大学附属北京安贞医院心外科,北京100029 [2]海南医学院第二附属医院心血管外科,海口570311

出　　处：《中华胸心血管外科杂志》2023年第5期303-308,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探究术前的糖化血红蛋白(HbA1c)控制情况对患有心脏疾病合并房颤的糖尿病患者行心脏外科手术联合Cox-MazeⅣ消融术的影响。方法回顾性分析2016年5月至2020年2月在我院接受心脏外科手术联合Cox-MazeⅣ消融术的317例心脏外科疾病合并房颤的糖尿病患者。术后随访(37.7±27.7)个月,收集对比房颤复发和临床结局资料。采用限制性立方样条模型分析HbA1c水平与房颤复发之间计量反应关系。通过单因素及多因素Cox比例回归分析探索Cox-MazeⅣ消融术后房颤复发的危险因素。结果在进行心脏外科手术联合Cox-MazeⅣ消融术时,较高的HbA1c水平显著增加术后房颤的复发率。术前HbA1c<7.4%的患者在12、24、36和48个月时的累积免房颤复发率分别为100%、92.6%、64.3%和62.8%,而对于术前HbA1c≥7.4%的患者,在12、24、36和48个月时房颤复发的累积生存率分别为96.3%、75.8%、52.7%和35.7%(P<0.001)。除此之外,术前HbA1c≥7.4%的患者全因病死率显著升高(6.3%对1.7%,P=0.03);心源性病死率显著升高(5.6%对1.1%,P=0.02),再住院率也显著升高(20.4%对5.7%,P=0.01)。多因素Cox回归分析显示HbA1c是Cox-MazeⅣ消融术后房颤复发的独立危险因素(P<0.05)。结论术前较高的HbA1c水平可以增加心脏外科手术联合Cox-MazeⅣ消融术患者术后房颤复发率以及不良临床结局事件。Objective This study was performed to assess the effect of glycemic control on atrial fibrillation recurrence rates after heart surgery concomitant with Cox-MazeⅣablation.Methods A retrospective analysis was performed on 317 diabetic patients with atrial fibrillation who underwent cardiac surgery combined with Cox-MazeⅣablation in our hospital from May 2016 to February 2020.The patients were followed up for(37.7±27.7)months,and the data of atrial fibrillation recurrence and clinical outcome were collected and compared.The limited cubic spline model was used to analyze the dose-relationship between HbA1c level and the recurrence of atrial fibrillation.The univariate and multivariate Cox proportional regression analysis was used to explore the risk factors of recurrent atrial fibrillation after Cox-MazeⅣablation.Results Higher glycated hemoglobin(HbA1c)at the time of ablation was associated with higher post-ablation recurrence rates.The cumulative survival freedom from atrial fibrillation recurrence for patients with HbA1c≥7.4%at time of operation at 12,24,36 and 48 months were 96.3%、75.8%、52.7%and 35.7%,respectively(P<0.001).Besides,the rates of all-cause mortality,cardiac mortality and rehospitalization were significantly lower in patients with HbA1c<7.4%(1.7%vs.6.3%,P=0.03;1.1%vs.5.6%,P=0.02 and 5.7%vs.20.4%,P=0.01).The multivariate Cox regression model showed that HbA1c was an independent risk factor for atrial fibrillation recurrence(P<0.05).Conclusion Higher preoperative HbA1c levels were associated with increased recurrence of atrial fibrillation and adverse clinical outcomes in patients undergoing cardiac surgery combined with Cox-MazeⅣablation.

关 键 词：糖化血红蛋白 房颤 心脏外科手术 糖尿病 房颤复发 

分 类 号：R654.2[医药卫生—外科学]