中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

非体外循环下冠状动脉旁路移植术后新发心房颤动的危险因素分析

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目的 探讨非体外循环下冠状动脉旁路移植(off-pump coronary artery bypass grafting,OPCAB)术后新发心房颤动(new-onset post-operative atrial fibrillation,POAF)的危险因素。 方法 回顾性分析泰达国际心血管病医院心脏外科 2016 年 1 月至 2018 年 1 月行单纯 OPCAB 的 583 例患者的临床资料。根据术后是否发生 POAF 而分为 POAF 组和非 POAF 组。对两组患者围术期的临床参数分别进行单因素分析。而后,将单因素分析中具有统计学意义的因素纳入多因素 logistics 回归分析,以确定其是否为 P0AF 的独立危险因素。 结果 共有 158 例发生了 POAF,发生率为 27.1%。单因素分析结果显示,年龄≥65 岁(P=0.012)、既往有慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)病史(P=0.028)、左房内径(LAD)≥38 mm(P=0.016)及中性粒细胞与淋巴细胞比值(NLR)(P=0.002)与 POAF 相关。logistic 多因素回归分析显示,年龄≥65 岁(OR=0.717,P=0.006)、LAD≥38 mm(OR=1.562,P=0.023)及较高的 NLR(OR=1.215,P=0.022)是 POAF 的独立危险因素,而既往有 COPD 病史(OR=2.489,P=0.326)无统计学意义。 结论 在 OPCAB 的患者中,高龄(年龄≥65 岁)、LAD 扩大(≥38 mm)及较高的 NLR 水平是 POAF 的独立危险因素。

Objective To investigate the risk factors of new-onset post-operative atrial fibrillation(POAF) in patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB). Methods Between January 2016 and January 2018, a total of 586 583 patients who underwent OPCAB in TEDA international cardiovascular hospital were retrospectively analyzed. The patients were divided into 2 groups, the POAF group and the non-POAF group, in accordance with the occurrence of POAF. The perioperative clinical parameters of the two groups were analyzed by univariate analysis. Then, statistically significant factors in the univariate analysis were subjected to multivariate logistic regression analysis to determine if it was an independent risk factor for POAF. Results The incidence of POAF after OPCAB was 27.1% (159 158 cases). Univariate analysis showed that age≥65 years old (P=0.012), history of chronic obstructive pulmonary disease (COPD) (P=0.028), left atrial diameter (LAD)≥38 mm (P=0.016) and neutrophil-lymphocyte ratio (NLR) (P=0.002) were related to POAF. Logistic multivariate regression analyses showed age≥65 (OR=0.717, P=0.006), LAD≥38 mm (OR=1.562, P=0.023) and higher NLR level (OR=1.215, P=0.022) were the independent risk factors of POAF after OPCAB, but not previous history of COPD (OR=2.489, P=0.326). Conclusion In patients with OPCAB, advanced age(≥65 years old), LAD enlargement(≥38 mm) and higher NLR level were the independent risk factors of POAF after OPCAB.

关键词: 冠状动脉旁路移植术; 心房颤动; 危险因素

Key words: Coronary artery bypass grafting; atrial fibrillation; risk factor

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