非体外循环冠状动脉移植术后新发心房颤动的预测  

Prediction of new-onset atrial fibrillation after off-pump coronary artery bypass grafting

作　　者：田海娇 赵海鹏 顾松 张希涛 安向光 刘岩 彭源舒 苏丕雄 TIAN Haijiao;ZHAO Haipeng;GU Song;ZHANG Xitao;AN Xiangguang;LIU Yan;PENG Yuanshu;SU Pixiong(Department of Heart Center and Beijing Key Laboratory of Hypertension,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心高血压病研究北京市重点实验室,100020

出　　处：《心肺血管病杂志》2024年第12期1294-1299,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市科技计划(Z191100006619036)。

摘　　要：目的:探讨单纯不停跳冠状动脉旁路移植术(off-pump coronary artery bypass grafting,off-pump CABG)术后新发心房颤动(postoperative atrial fibrillation,POAF)发生的危险因素,建立风险预测模型,从而为预防及治疗off-pump CABGPOAF提供依据。方法:本研究纳入CABG患者439例,观察单纯off-pump CABGPOAF的发生率,通过回归分析筛选变量建立风险预测模型,绘制ROC曲线,并评估其预测效能。结果:POAF的发生率为12.1%(53/439),POAF的发生显著增加患者术后住院时长(P=0.001)、ICU停留时间(P<0.001)、机械通气时间(P<0.001)及出院时死亡风险(P=0.005)。POAF组患者较非POAF组患者有着更大的年龄(P<0.001)、更高的TC/LDH-C比值、更低的eGFR(P=0.010)。回归分析显示:年龄>70岁为危险因素(OR=10.159,95%CI:1.286~80.261),除此外,TC/LDL-C比值、LVEF、左心房内径、ACEI类药物的使用、也与POAF的发生显著相关。ROC曲线下面积为(0.762,95%CI:0.692~0.833,P<0.001)。结论:单纯不停跳冠状动脉移植POAF的发生与众多因素相关,主要包括患者年龄、血脂水平、术前ACEI类药物的使用、左心功能等。术前抗心律失常药物及他汀类药物的应用对POAF的发生无影响。Objective:This study aims to explore the risk factors for postoperative atrial fibrillation(POAF)following off-pump coronary artery bypass grafting(off-pump CABG)and establish a risk prediction model,thus providing a theoretical basis for the prevention and treatment of POAF after off-pump CABG in clinical practice.Methods:Patients undergoing off-pump CABG without cardiopulmonary bypass were included in this study.The incidence of POAF after off-pump CABG was observed.Regression analysis was performed to select variables for establishing a risk prediction model.ROC curves were plotted,and their predictive performance was evaluated.Results:In this study,the incidence of postoperative atrial fibrillation(POAF)was 12.1%(53/439),which significantly increased the length of hospital stay(P=0.001),ICU stay duration(P<0.001),mechanical ventilation time(P<0.001),and the risk of mortality at discharge(P=0.005).Patients with POAF had a higher age(P<0.001),higher total cholesterol/lowdensity lipoprotein ratio,and lower glomerular filtration rate(P=0.010)compared to those without POAF.Regression analysis indicated that age over 70 was an independent risk factor(OR=10.159,95%CI:1.286-80.261).Additionally,total cholesterol/low-density lipoprotein ratio,left ventricular ejection fraction,left atrial diameter,and the use of ACEI were significantly associated with POAF.The established risk prediction model had an area under the ROC curve of 0.762,with P=0.406.Conclusion:The occurrence of POAF after off-pump coronary artery bypass grafting is associated with multiple factors,including patient age,lipid levels,preoperative use of ACEI,and left ventricular function.The use of antiarrhythmic drugs and statins before surgery has no effect on the occurrence of POAF.

关 键 词：非体外循环冠状动脉旁路移植术 术后新发心房颤动 预测因素 

分 类 号：R54[医药卫生—心血管疾病]