术前房性早搏与肥厚型心肌病术后新发心房颤动的相关性  

Correlation between Preoperative Premature Atrial Contractions and Postoperative Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy

作　　者：蒙延海[1] 聂长荣 张燕搏[1] 卢涛 胡恩慈[1] 尚基高 朱昌盛[2] 陆政阳 王水云[2] MENG Yanhai;NIE Changrong;ZHANG Yanbo;LU Tao;HU Enci;SHANG Jigao;ZHU Changsheng;LU Zhengyang;WANG Shuiyun(Adult Surgery ICU,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Bejing 100037,China;Adult Surgery Center,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Bejing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室成人术后恢复中心,北京100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室成人外科中心,北京100037

出　　处：《中国分子心脏病学杂志》2024年第3期6076-6082,共7页Molecular Cardiology of China

基　　金：中央高水平医院临床科研业务费(零余额2023-GSP-QN-14,零余额2022-GSP-GG-29,零余额2023-GSP-GG-11);中国医学科学院医学与健康科技创新工程重大协同创新项目(2023-I2M-1-001);中央高校基本科研业务费专项资金(3332022019)。

摘　　要：目的分析接受手术治疗的梗阻性肥厚型心肌病(OHCM)患者不同术前房性早搏(PACs)负荷与术后新发心房颤动(POAF)之间的相关性。方法回顾性分析2015年1月至2018年12月中国医学科学院阜外医院收治的288例无心房颤动史的OHCM患者术前及围手术期资料。所有患者均接受室间隔肌心肌切除术,术前均行24 h动态心电图监测。结果243例(84.4%)患者存在PACs,45例(15.6%)患者无PACs。以100次/24 h的PACs数目作为截定点,211例(73.3%)患者低负荷PACs(PACs数目<100次/24 h),32例(11.1%)患者高负荷PACs(PACs数目≥100次/24 h)。66例OHCM患者发生POAF,其中非PACs组3例(6.7%),低负荷PACs组47例(22.3%),高负荷PACs组16例(50.0%)。低负荷PACs组、高负荷PACs组患者POAF发生率均高于无PACs组患者(P均<0.01)。多因素logistic回归分析结果表明,高负荷PACs(P=0.02)和年龄(P<0.01)能独立预测OHCM患者POAF发生。结论术前高负荷PACs的OHCM患者(PACs数目≥100次/24 h)单纯室间隔心肌切除术后POAF发生率明显增加,高负荷PACs和年龄是预测OHCM患者POAF的独立预测因子。Objective To investigate the correlation between different preoperative premature atrial contractions(PACs)loads and postoperative atrial fibrillation(POAF)in obstructive hypertrophic cardiomyopathy(OHCM)patients undergoing surgery.Methods Preoperative and perioperative data of 288 consecutive OHCM patients without a history of atrial fibrillation,who underwent interventricular septum myectomy between January 2015 and December 2018,were retrospectively analyzed.All patients underwent 24-hour ambulatory electrocardiographic monitoring before surgery.Results PACs were present in 243(84.4%)patients,while 45(15.6%)patients did not have PACs.Based on the number of PACs using 100 beats/24 hours as a cutoff point,211(73.3%)patients had a low PAC burden and 32(11.1%)patients had a high PAC burden.Postoperatively,POAF occurred in 66 OHCM patients:3/45(6.7%)in the non-PACs group,47/211(22.3%)in the low PACs group,and 16/32(50.0%)in the high PACs group.The incidence of POAF was significantly higher in both the low PACs and high PACs groups compared to patients without PACs(bothP<0.01).Multifactorial logistic regression analysis revealed that high PAC burden(P=0.02)and age(P<0.01)independently predicted POAF in OHCM patients.Conclusion The incidence of POAF is significantly higher in patients with preoperative high-burden PACs(≥100 beats/24 hours),and both high PACs burden and age are independent predictors of POAF in patients with OHCM.

关 键 词：房性早搏 术后新发心房颤动 梗阻性肥厚型心肌病 

分 类 号：R654.2[医药卫生—外科学]