天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (7): 708-711.doi: 10.11958/20180503

• 临床研究 • 上一篇    下一篇

单纯非体外循环冠状动脉旁路移植术后新发房颤 术前相关危险因素分析

张凯，王联群△   

  1. 天津市胸科医院心脏外科（邮编300222）
  • 收稿日期:2018-03-30 修回日期:2018-05-04 出版日期:2018-07-15 发布日期:2018-07-15
  • 通讯作者: 王联群 E-mail:lianqun1964@hotmail.com
  • 作者简介:张凯（1981），男，硕士，主治医师，主要从事心脏血管外科的相关工作

The preoperative risk factors for new onset atrial fibrillationin after off-pump coronary artery bypass grafting

ZHANG Kai，WANG Lian-qun△   

  1. Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin 300222, China
    △Corresponding Author E-mail: lianqun1964@hotmail.com
  • Received:2018-03-30 Revised:2018-05-04 Published:2018-07-15 Online:2018-07-15
  • Contact: Lianqun Wang E-mail:lianqun1964@hotmail.com

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摘要： 目的 探讨单纯非体外循环下冠状动脉旁路移植术（CABG）患者术后新发房颤（POAF）发生的术前相关 危险因素。方法 单纯非体外循环下CABG患者1 888例，根据POAF定义分为新发房颤组（POAF组，389例）与未发 房颤组（NPOAF组，1 499例）。单因素分析2组患者一般临床资料、术前生化指标、术前心脏超声、冠状动脉病变及术 前用药情况，对差异有统计学意义的指标进一步行Logistics回归分析。结果 POAF发生率为20.60%（389/1 888）， POAF组年龄、慢性阻塞性肺疾病（COPD）病史和心肌梗病史比例、术前尿素氮（BUN）水平、左心房内径（LAD）、左室 舒张末期内径（LVEDD）均高于NPOAF组，术前心功能HYHA分级劣于NPOAF组（P＜0.05）；POAF组患者术前应用 β受体阻滞剂比例明显低于NPOAF组（P＜0.01）；Logistic回归分析结果显示，高龄与LAD增大是发生POAF的术前 独立危险因素，术前应用β受体阻滞剂是POAF发生的保护因素。结论 年龄、LAD及术前β受体阻滞剂应用与单纯 非体外循环下CABG患者POAF发生有一定相关性。

关键词: 冠状动脉旁路移植术, 非体外循环, 术后新发房颤, 危险因素, 术前

Abstract: Objective To investigate the preoperative risk factors of postoperative atrial fibrillation (POAF) in patients undergoing off-pump coronary artery bypass grafting (CABG). Methods A total of 1 888 patients underwent off-pump CABG in our hospital were divided into new onset atrial fibrillation group (POAF group, n=389) and non AF group (NPOAF group, n=1 499). Univariate analysis was used to compare general clinical data, preoperative biochemical indicators, preoperative echocardiography, coronary artery disease and preoperative medication between two groups. The indicators with statistically significant differences were further analyzed by Logistics regression analysis. Results The incidence of POAF was 20.60% (389 / 1 888). The data of age, chronic obstructive pulmonary disease (COPD) history, myocardial infarction history, preoperative urea nitrogen (BUN) level, left atrial diameter (LAD) and left ventricular end diastolic diameter (LVEDD) were higher in POAF group than those of NPOAF group, and the preoperative HYHA grading was lower in POAF group than that of NPOAF group（P＜0.05). The proportion of preoperative use of beta blockers was significantly lower in POAF group than that of NPOAF group (P＜0.01). Logistic regression analysis showed that increased age and LAD were independent preoperative risk factors for POAF. Preoperative beta blocker application was a protective factor for POAF. Conclusion It suggests that age, LAD and preoperative beta blocker application are related to the occurrence of POAF in patients underwent off-pump CABG.

Key words: coronary artery bypass, off-pump, postoperative new atrial fibrillation, risk factors, preoperative