天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (8): 877-880.doi: 10.11958/20170317

• 临床研究 • 上一篇    下一篇

单纯体外循环下冠脉搭桥术新发术后房颤危险因素分析

薛奋龙， 柴军武， 陈洪磊， 周巍， 王凯△， 孔祥荣   

  1. 天津市第一中心医院心血管外科 （邮编 300192）
  • 收稿日期:2017-03-13 修回日期:2017-06-20 出版日期:2017-08-15 发布日期:2017-08-15
  • 通讯作者: △通讯作者 E-mail: 13820008013@163.com E-mail:lpxfl@163.com
  • 作者简介:薛奋龙 （1986）， 男， 硕士研究生， 住院医师， 主要从事心血管外科临床研究

Analysis of risk factors of new onset atrial fibrillation after on-pump coronary artery bypass grafting

XUE Fen-long, CHAI Jun-wu, CHEN Hong-lei, ZHOU Wei, WANG Kai△, KONG Xiang-rong   

  1. Department of Cardiac Surgery, Tianjin First Central Hospital, Tianjin 300192, China
  • Received:2017-03-13 Revised:2017-06-20 Published:2017-08-15 Online:2017-08-15
  • Contact: △Corresponding Author E-mail: 13820008013@163.com E-mail:lpxfl@163.com

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摘要： 目的 探讨单纯体外循环下冠脉搭桥术 （ONCAB） 新发术后房颤 （POAF） 的危险因素。方法 收集 200 例 单纯体外循环冠脉搭桥术患者临床资料， 按是否存在 POAF 分为 POAF 组 （52 例） 和非 POAF 组 （148 例）。对 2 组患 者的年龄、 性别等一般资料进行分析， 将结果有统计学意义的指标采用二分类 Logistic 回归筛选 POAF 发生的影响 因素， 并绘制受试者工作特征（ROC）曲线评价其预测价值。结果 POAF 发生率 26.0%， 多发生于术后 1～3 d。与 非 POAF 组相比， POAF 组年龄、 年龄≥62.5 岁比例、 左房直径 （LAD） ≥35 mm 比例、 左室舒张末期内径、 围术期输悬浮 红细胞（RBC）量均升高， 呼吸机辅助时间、 ICU 停留时间、 住院时间均延长， 但左室射血分数（LVEF）水平降低（P＜ 0.05）； 其中， 高龄（≥62.5 岁）、 LAD 增大（≥35 mm）、 较高的围术期 RBC 输注量是 ONCAB 术后发生 POAF 的危险因 素， 较高的 LVEF 是 POAF 的保护因素。年龄、 输 RBC 量、 LAD 及 LVEF 的最佳临界值分别为 62.5 岁、 1 U、 35.5 mm 及 0.34。结论 ONCAB 术后 POAF 的发生与老龄 （≥62.5 岁）、 LAD 增大 （≥35 mm）、 围术期输注 RBC 量具有一定相 关性， 可用于临床预测 POAF 的发生。

关键词: 心房颤动, 手术后并发症, 危险因素, Logistic 模型, ROC 曲线, 冠状动脉旁路移植术, 体外循环

Abstract: Objective To investigate the risk factors of postoperative atrial fibrillation (POAF) in patients with onpump coronary artery bypass grafting (ONCAB). Methods The clinical data of 200 patients with ONCAB were retrospectively analyzed. The patients were divided into POAF group (n=52) and non POAF group (n=148) according to the occurrence of POAF after operation. The perioperative data including age and gender of all patients were collected and analyzed. The index of opinion of statistical results was classified by two categories Logistic regression analysis, and the related risk factors of POAF were analyzed. The receiver operating characteristic (ROC) curves of the age, red blood cell (RBC), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) were analyzed in two groups. Results The incidence rate of POAF was 26%, mostly occurred in the postoperative period from 1 d to 3 d. Compared with non POAF group, the age, the proportion of patients with age ≥ 62.5 years or older, the proportion of patients with LAD ≥ 35 mm, left ventricular end- diastolic diameter and perioperative transfusion of RBC were increased in POAF group, and data of mechanical ventilation time, ICU stay time and hospitalization time were prolonged, but the LVEF level decrease (P < 0.05). Among them, the elderly (≥ 62.5 years), increased LAD (≥ 35 mm), the higher perioperative transmission amount of RBC were the independent risk factors of POAF after ONCAB, and the higher LVEF was a protective factor for ONCAB. The optimal thresholds for age, RBC, LAD and LVEF were 62.5 years, 1U, 35.5 mm, and 0.34. Conclusion The occurrence of POAF after ONCAB is related with age ( ≥ 62.5 years old)， LAD ≥ 35 mm and perioperative transfusion of RBC, which can be used as clinically to predict the occurrence of POAF.

Key words: atrial fibrillation, postoperative complications, risk factors, Logistic models, ROC curve, coronary artery bypass,on-pump