冠心病患者OPCABG术后新发心房颤动的危险因素分析及干预措施  

Risk Factors and Intervention Measures for New Onset Atrial Fibrillation in Patients with Coronary Heart Disease After OPCABG Surgery

作　　者：沙丽[1] 王亚心 赵燕[1] 李艳鑫[2] 魏彦慧 肖玉向 张海燕 SHA Li;WANG Yaxin;ZHAO Yan;LI Yanxin;WEI Yanhui;XIAO Yuxiang;ZHANG Haiyan(Department of Cardiac Surgery,Henan Provincial Chest Hospital,Zhengzhou 450000,China;Outpatient Department,Henan Provincial Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院心外科,河南郑州450000 [2]河南省胸科医院门诊部,河南郑州450000

出　　处：《河南医学研究》2024年第19期3494-3498,共5页Henan Medical Research

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190731)。

摘　　要：目的探讨冠心病患者非体外循环冠状动脉旁路移植术(OPCABG)术后新发心房颤动的危险因素并建立logistic回归模型,分析该模型对术后新发心房颤动的预测价值,为临床制定干预措施提供参考。方法回顾性选取2021年10月至2023年8月河南省胸科医院收治的175例冠心病患者,依据OPCABG术后5 d是否新发心房颤动分为发生组49例、未发生组126例。比较两组临床资料,经多因素logistic回归分析术后新发心房颤动的影响因素,并建立logistic回归模型。采用受试者工作特征(ROC)曲线评价该模型对术后新发心房颤动的预测效能,Hosmer-Lemeshow法评价该模型的拟合度。结果左心房容积指数、术后主动脉内球囊反搏(IABP)辅助、右冠状动脉近段狭窄≥75%及术前中性粒细胞淋巴细胞比值(NLR)、血清生长分化因子15(GDF-15)为术后新发心房颤动的独立危险因素(P<0.05)。logistic回归模型预测术后新发心房颤动的曲线下面积(AUC)为0.928,敏感度、特异度分别为89.80%、85.71%,且具有良好校准能力。结论左心房容积指数、术后IABP辅助、右冠状动脉近段狭窄≥75%及术前NLR、血清GDF-15为冠心病患者OPCABG术后新发心房颤动的独立危险因素,基于上述影响因素建立logistic回归模型,该模型对术后新发心房颤动具有一定预测价值,临床可依据该模型筛选高危人群,采取积极干预措施,以降低术后新发心房颤动的发生风险。Objective To investigate the risk factors of new onset atrial fibrillation after off-pump coronary artery bypass grafting(OPCABG)in patients with coronary heart disease and establish a logistic regression model to analyze the predictive value of the model for new onset atrial fibrillation after OPCABG,so as to provide reference for clinical intervention.Methods A total of 175 patients with coronary heart disease in Henan Provincial Chest Hospital from October 2021 to August 2023 were selected,and they were divided into the occurrence group(49 cases)and the non occurrence group(126 cases)according to whether new atrial fibrillation occurred 5 days after OPCABG.The clinical data of the two groups were compared,and the influencing factors of postoperative new onset atrial fibrillation were analyzed by multivariate logistic regression,and the logistic regression model was established.The receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of the model for postoperative new onset atrial fibrillation,Hosmer-Lemeshow was used to evaluate the fitting degree of the model,and the decision curve was used to evaluate the clinical net return rate of the model.Results Left atrial volume index,postoperative intra-aortic balloon counterpulsation(IABP)assistance,stenosis of the proximal segment of the right coronary artery≥75%,and preoperative neutrophil-to-lymphocyte ratio(NLR)and serum growth differentiation factor 15(GDF-15)were independent risk factors for new-onset atrial fibrillation after surgery(P<0.05).The AUC of the logistic regression model for predicting new-onset atrial fibrillation after surgery was 0.928,with sensitivity and specificity of 89.80%and 85.71%,respectively,and good calibration ability.Conclusion Left atrial volume index,postoperative IABP assistance,stenosis of the proximal segment of the right coronary artery≥75%,preoperative NLR,and serum GDF-15 are independent risk factors for new-onset atrial fibrillation after OPCABG in patients with coronary heart disease.

关 键 词：冠心病 非体外循环冠状动脉旁路移植术 心房颤动 预测 

分 类 号：R543[医药卫生—心血管疾病]