食管调搏终止心外科术后心房扑动的疗效及影响因素分析  

Curative efficacy and influencing factors of transesophageal atrial pacing to terminate atrial flutter after cardiac surgery

作　　者：赵少锋 陈元禄[2] 陈庆华[2] 高静[3] 崔壮 ZHAO Shaofeng;CHEN Yuanlu;CHEN Qinghua;GAO Jing;CUI Zhuang(Department of Health Stalistics,School of Public Health,Tianjin Medical University,Tianjin 300070,China;Department of Electrophysiology,TEDA International Cardiovascular Hospital;Tianjin Cardiovascular Diseases Institute)

机构地区：[1]天津医科大学公共卫生学院流行病与卫生统计学系,300070 [2]泰达国际心血管病医院电生理科 [3]天津市心血管病研究所

出　　处：《天津医药》2023年第11期1245-1249,共5页Tianjin Medical Journal

基　　金：天津市科技支撑重点项目(S20ZC631269)。

摘　　要：目的 探讨经食管心房调搏(TEAP)终止心外科术后心房扑动的临床疗效及影响因素。方法 单中心心脏外科术后5 d内发生心房扑动的患者298例,按治疗方案不同分为胺碘酮治疗(对照)组150例和TEAP治疗(观察)组148例,分析2组心房内径和手术相关指标差异,以及有效率、不良反应、术后6个月的复发率等差异。Logistic回归分析影响TEAP终止房扑疗效的因素。结果 2组心房内径及手术相关指标差异均无统计学意义。与对照组比较,观察组治疗有效率增加(47.3%vs. 83.8%,P<0.05),2组不良反应、住院期间病死率、术后6个月的复发率差异无统计学意义。较大的左房前后径(OR=1.156,95%CI:1.066~1.255)、连续刺激终止方式(OR=6.019,95%CI:1.911~18.953)是TEAP治疗房扑失败的独立危险因素。结论 TEAP终止心脏外科术后心房扑动疗效可靠,刺激方式建议采用递增刺激。Objective To investigate the clinical efficacy and influencing factors of transesophageal atrial pacing(TEAP)for atrial flutter after cardiac surgery.Methods A total of 298 patients with atrial flutter within 5 days after cardiac surgery in a single center were divided into the amiodarone group(control group,n=150)and the TEAP group(observation group,n=148)according to different treatment regimens.The differences of atrial diameter,operation related indicators,effective rate,adverse reactions and recurrence rate 6 months after operation were analyzed between the two groups.Logistic regression analysis was performed to analyze factors affecting the efficacy of TEAP terminating atrial flutter.Results There were no significant differences in atrial diameter and operation related parameters between the two groups.Compared with the control group,the effective rate was increased in the observation group(47.3%vs.83.8%,P<0.05).There were no significant differences in adverse reactions,mortality during hospitalization and recurrence rate 6 months after operation between the two groups.Larger left atrial anteroposterior diameter(OR=1.156,95%CI:1.066-1.255),continuous equal frequency stimulation(continuous stimulation)and termination mode(OR=6.019,95%CI:1.911-18.953)were independent risk factors for failure of atrial flutter in TEAP treatment.Conclusion TEAP is reliable to terminate atrial flutter after cardiac surgery.Continuous incremental stimulation(incremental stimulation)is recommended.

关 键 词：心脏外科手术 心房扑动 电生理学技术 心脏 危险因素 方案评价 

分 类 号：R654.2[医药卫生—外科学]