阻塞性睡眠呼吸暂停低通气综合征与冠状动脉旁路移植术后新发心房颤动的关系  

Relationship between obstructive sleep apnea hypopnea syndrome and new-onset atrial fibrillation after coronary artery bypass grafting

作　　者：王梦歌 欧阳松云[1] 徐敬[2] 黄功成 马小花[1] 孙琳歌 刘艳君[1] WANG Mengge;OUYANG Songyun;XU Jing;HUANG Gongcheng;MA Xiaohua;SUN Linge;LIU Yanjun(Department of Respiratory and Sleep Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Cardiac Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院呼吸睡眠科,河南郑州450052 [2]郑州大学第一附属医院心脏外科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2024年第1期29-34,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金河南联合基金(U1804195)。

摘　　要：目的 观察行冠状动脉旁路移植术(CABG)的冠心病患者阻塞性睡眠呼吸暂停低通气综合征(OSAHS)发生情况,探讨OSAHS与CABG术后新发心房颤动(房颤)的关系。方法 2022年1—12月郑州大学第一附属医院行CABG治疗的冠心病患者156例,术前均行多导睡眠监测并进行OSAHS分级,49例中重度OSAHS者为中重度OSAHS组,57例轻度OSAHS者为轻度OSAHS组,50例OSAHS分级正常者为正常组。比较3组性别比例、年龄、合并症(糖尿病、高血压)、体质量指数,术前呼吸暂停低通气指数(AHI)、低密度脂蛋白胆固醇、血肌酐、高敏C反应蛋白水平及左心房内径、左室射血分数、左心室舒张末期容积;记录搭桥支数,围手术期主动脉内球囊反搏(IABP)/体外膜肺氧合(ECMO)治疗、胸腔积液、肺部感染比率及机械通气时间、ICU治疗时间、住院时间。术后3个月复查超声心动图,记录左心房内径、左室射血分数、左心室舒张末期容积。随访至2023年3月,记录随访期间新发房颤及因再狭窄、血栓形成、桥血管失功、心律失常、心绞痛等主要不良心血管事件再次入院情况。采用单因素和多因素logistic回归分析冠心病合并OSAHS患者CABG术后新发房颤的影响因素;绘制ROC曲线,评估术前高敏C反应蛋白、AHI预测冠心病合并OSAHS患者CABG术后新发房颤的效能。结果 (1)3组体质量指数、AHI比较差异有统计学意义(F=18.388,P<0.001;F=15.469,P<0.001),正常组、轻度OSAHS组、中重度OSAHS组体质量指数[(22.3±1.1)、(25.3±2.1)、(26.9±1.8)kg/m~2]、AHI[(2.3±2.1)、(8.4±3.6)、(28.0±7.9)次/h]均依次升高(P<0.05);3组性别比例、年龄及合并高血压、糖尿病比率比较差异均无统计学意义(P>0.05)。(2)3组术前低密度脂蛋白胆固醇、血肌酐水平及左心房内径、左室射血分数、左心室舒张末期容积,搭桥支数,IABP/ECMO治疗、胸腔积液、肺部感染比率,术后3个月左心房内径比较差异均无Objective To observe the occurrence of obstructive sleep apnea hypopnea syndrome(OSAHS) in patients with coronary heart disease before coronary artery bypass grafting(CABG),and to explore the relationship between OSAHS and new-onset atrial fibrillation after CABG.Methods Totally 156 patients with coronary heart disease underwent polysomnography and OSAHS grading before CABG in the First Affiliated Hospital of Zhengzhou University from January to December 2022,and were divided into moderate to severe OSAHS group(n=49),mild OSAHS group(n=57),and normal OSAHS group(n=50).The gender ratio,age,diabetes,hypertension,body mass index,apnea-hypopnea index(AHI),low-density lipoprotein cholesterol,blood creatinine and high sensitivity C-reactive protein,left atrial diameter(LAD),left ventricular ejection fraction(LVEF),and left ventricular end-diastolic volume(LVEDV) before CABG were compared among three groups.The number of bypass grafts,intra-aortic balloon pump(IABP)/extracorporeal membrane oxygenation(ECMO) therapy,pleural effusion,pulmonary infection,mechanical ventilation time,length of ICU stay,and length of hospital stay were recorded.Echocardiography was done again 3 months after CABG to record the LAD,LVEF and LVEDV.The follow-up was done till March 2023 to record the incidence of new-onset atrial fibrillation and readmission due to major adverse cardiovascular events such as restenosis,thrombosis,bridging dysfunction,arrhythmia and angina.Univariate and multivariate logistic regression analyses were conducted to evaluate the influencing factors of new-onset atrial fibrillation after CABG in patients with coronary heart disease complicated with OSAHS.ROC curves were plotted to assess the efficiencies of preoperative high sensitivity C-reactive protein and AHI on predicting new-onset atrial fibrillation after CABG.Results(1) There were significant differences in the body mass index and AHI among three groups(F=18.388,P<0.001;F=15.469,P<0.001).The body mass index and AHI increased sequentially in normal group [(22.3

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 冠状动脉旁路移植术 高敏C反应蛋白 呼吸暂停低通气指数 

分 类 号：R541.75[医药卫生—心血管疾病] R766[医药卫生—内科学] R654.2[医药卫生—临床医学]