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

查看全文

目的 探讨非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCAB)后新发心房颤动(new-onset postoperative 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 583 例患者的临床资料,其中男 434 例、女 149 例,平均年龄(62.79±8.08)岁。根据患者是否发生 POAF 而分为 POAF 组(158 例)和非 POAF 组(425 例)。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 logistic 回归分析,以确定其是否为 POAF 的独立危险因素。 结果 单因素分析结果显示,年龄≥65 岁(P=0.012)、既往慢性阻塞性肺疾病(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=1.717,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 postoperative 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 583 patients who underwent OPCAB in TEDA International Cardiovascular Hospital were retrospectively analyzed. There were 434 males and 149 females with an average age of 62.79±8.08 years. The patients were divided into 2 groups, a POAF group (n=158) and a non-POAF group (n=425) , 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 Univariate analysis showed that age≥65 years (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 analysis showed that age≥65 years (OR=1.717, 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), LAD enlargement (≥38 mm) and higher NLR level are 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

引用本文: 郑思强, 刘志刚, 刘晓程. 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. 中国胸心血管外科临床杂志, 2019, 26(3): 229-232. doi: 10.7507/1007-4848.201806009 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Bohatch Júnior MS, Matkovski PD, Di Giovanni FJ, et al. Incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2015, 30(3): 316-324.
2. Phan K, Ha HS, Phan S, et al. New-onset atrial fibrillation following coronary bypass surgery predicts long-term mortality: a systematic review and meta-analysis. Eur J Cardiothorac Surg, 2015, 48(6): 817-824.
3. Maesen B, Nijs J, Maessen J, et al. Post-operative atrial fibrillation: a maze of mechanisms. Europace, 2012, 14(2): 159-174.
4. Haffajee JA, Lee Y, Alsheikh-Ali AA, et al. Pre-operative left atrial mechanical function predicts risk of atrial fibrillation following cardiac surgery. JACC Cardiovasc Imaging, 2011, 4(8): 833-840.
5. Møller CH, Steinbrüchel DA. Off-pump versus on-pump coronary artery bypass grafting. Curr Cardiol Rep, 2014, 16(3): 455.
6. Diegeler A, Börgermann J, Kappert U, et al. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med, 2013, 368(13): 1189-1198.
7. Houlind K, Kjeldsen BJ, Madsen SN, et al. On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. Circulation, 2012, 125(20): 2431-2439.
8. Archbold RA, Curzen NP. Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation. Heart, 2003, 89(10): 1134-1137.
9. Ashes CM, Yu M, Meineri M, et al. Diastolic dysfunction, cardiopulmonary bypass, and atrial fibrillation after coronary artery bypass graft surgery. Br J Anaesth, 2014, 113(5): 815-821.
10. Kowalewski M, Pawliszak W, Malvindi PG, et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis. J Thorac Cardiovasc Surg, 2016, 151(1): 60-77.
11. Lamy A, Devereaux PJ, Prabhakaran D, et al. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med, 2013, 368(13): 1179-1188.
12. Gu J, Andreasen JJ, Melgaard J, et al. Preoperative electrocardiogram score for predicting new-onset postoperative atrial fibrillation in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth, 2017, 31(1): 69-76.
13. Kojodjojo P, Kanagaratnam P, Markides V, et al. Age-related changes in human left and right atrial conduction. J Cardiovasc Electrophysiol, 2006, 17(2): 120-127.
14. Hakala T, Hedman A. Predicting the risk of atrial fibrillation after coronary artery bypass surgery. Scand Cardiovasc J, 2003, 37(6): 309-315.
15. Shen J, Lall S, Zheng V, et al. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. J Thorac Cardiovasc Surg, 2011, 141(2): 559-570.
16. Fujiwara M, Nakano Y, Hidaka T, et al. Prediction of atrial fibrillation after off-pump coronary artery bypass grafting using preoperative total atrial conduction time determined on tissue Doppler imaging. Circ J, 2014, 78(2): 345-352.
17. Açil T, Cölkesen Y, Türköz R, et al. Value of preoperative echocardiography in the prediction of postoperative atrial fibrillation following isolated coronary artery bypass grafting. Am J Cardiol, 2007, 100(9): 1383-1386.
18. Xu Y, Sharma D, Li G, et al. Atrial remodeling: new pathophysiological mechanism of atrial fibrillation. Med Hypotheses, 2013, 80(1): 53-56.
19. Gibson PH, Croal BL, Cuthbertson BH, et al. Use of preoperative natriuretic peptides and echocardiographic parameters in predicting new-onset atrial fibrillation after coronary artery bypass grafting: a prospective comparative study. Am Heart J, 2009, 158(2): 244-251.
20. Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther, 2016, 14(5): 573-577.
21. Shao Q, Chen K, Rha SW, et al. Usefulness of neutrophil/lymphocyte ratio as a predictor of atrial fibrillation: a meta-analysis. Arch Med Res, 2015, 46(3): 199-206.
22. Cerit L, Duygu H, Gulsen K, et al. Is SYNTAX score predictive of atrial fibrillation after on-pump coronary artery bypass graft surgery? Korean Circ J, 2016, 46(6): 798-803.
23. Xu S, Zhang J, Xu YL, et al. Relationship between angiotensin converting enzyme, apelin, and new-onset atrial fibrillation after off-pump coronary artery bypass grafting. Biomed Res Int, 2017, 2017: 7951793.
24. Durukan AB, Gurbuz HA, Unal EU, et al. Role of neutrophil/lymphocyte ratio in assessing the risk of postoperative atrial fibrillation. J Cardiovasc Surg (Torino), 2014, 55(2): 287-293.