心脏手术同期迷宫消融术后房颤复发的风险预测模型构建  

Construction of a risk prediction model for recurrence of atrial fibrillation after simultaneous maze ablation for cardiac surgery

作　　者：蔡岩坡 顾嘉玺 刘鸿 邵永丰 CAI Yanpo;GU Jiaxi;LIU Hong;SHAO Yongfeng(Department of Chest Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心脏大血管外科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2024年第6期868-875,共8页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(82100254)。

摘　　要：目的:探讨心脏手术同期行迷宫Ⅳ(MazeⅣ)消融治疗房颤术后复发的危险因素并构建其风险预测的列线图模型。方法:收集2014年1月-2022年12月南京医科大学第一附属医院心脏大血管外科收治的596例心脏手术同期行MazeⅣ消融的患者资料,依据术后1年内是否房颤复发将患者分为两组,采用单因素卡方检验、多因素Logistic回归、Cox回归模型分析术后1年房颤复发的独立危险因素,并构建房颤复发风险预测模型。结果:596例患者术后1年内有150例复发(25.2%)。单因素分析显示,年龄、房颤持续时间、左房内径(left atrium diameter,LAD)、右房内径(right atrium diameter,RAD)、既往起搏器置入、早期房颤复发是术后房颤复发的危险因素;多因素分析显示,年龄、房颤持续时间、LAD、早期房颤复发为独立危险因素;Cox回归分析显示,年龄[HR=1.035(1.025~1.068),P<0.001]、房颤持续时间[HR=1.003(1.001~1.006),P=0.003]、LAD[HR=1.025(1.006~1.044),P=0.009]、使用铰链式消融钳[HR=3.269(2.083~5.130),P<0.001]、术后早期房颤复发[HR=3.592(2.532~5.095),P<0.001]与房颤复发显著相关。根据受试者特征曲线分析年龄、房颤持续时间、LAD的截断值分别为59.5岁、9.5个月、51.5 cm。结论:MazeⅣ在维持窦性心律方面具有良好的长期疗效。对于接受心脏手术的房颤患者,较大的年龄、较长的LAD、房颤持续时间会对消融结果产生不利影响,依据此结果构建的危险模型有良好的预测效能。Objective:To explore the risk factors for postoperative recurrence of atrial fibrillation after concomitant MazeⅣablation for cardiac surgery and construct a nomogram model for risk prediction.Methods:Data were collected from 596 patients who underwent concurrent cardiac surgery and MazeⅣablation at the Department of Cardiac Macrovascular Surgery of the First Affiliated Hospital of Nanjing Medical University,from January 2014 to December 2022.Patients were divided into two groups based on whether atrial fibrillation recurred within 1 year postoperatively.Univariate chi-square test,multivariate logistic regression,and Cox regression models were used to analyze the independent risk factors for atrial fibrillation recurrence within 1 year postoperatively and to construct a risk prediction model.Results:Among the 596 patients,150(25.2%)experienced recurrences.Univariate analysis showed that age,duration of atrial fibrillation,left atrium diameter(LAD),right atrium diameter(RAD),prior pacemaker placement,and early atrial fibrillation recurrence were risk factors for postoperative recurrence of atrial fibrillation,while multifactorial analysis showed that age,duration of atrial fibrillation,LAD,and early atrial fibrillation recurrence were independent risk factors.Cox regression analysis demonstrated that age[HR=1.035(1.025-1.068),P<0.001],duration of atrial fibrillation(HR=1.003[1.001-1.006],P=0.003),LAD[HR=1.025(1.006-1.044),P=0.009],use of a hinged ablation forceps[HR=3.269(2.083-5.130),P<0.001],and early postoperative atrial fibrillation recurrence[HR=3.592(2.532-5.095),P<0.001]were significantly associated with atrial fibrillation recurrence.According to the receiver operating characteristic curve analysis,the cut-off values for age,duration of atrial fibrillation,and LAD were 59.5 years,9.5 months,and 51.5 cm,respectively.Conclusion:MazeⅣhas good long-term efficacy in maintaining sinus rhythm.In patients with atrial fibrillation undergoing cardiac surgery,older age,longer LAD,and longer duration of atrial f

关 键 词：房颤 MazeⅣ手术 列线图模型 

分 类 号：R654.2[医药卫生—外科学]