摘要
目的 探讨非体外循环冠状动脉旁路移植（off-pump coronary artery bypass graft,OPCAB）术后心房颤动（atrial fibrillation,AF）发生的相关危险因素。方法 回顾性分析沈阳军区总医院2014年1—6月468例OPCAB临床资料,按术后是否发生AF分为AF组和非AF组。并收集所有患者围术期资料,筛选分析OPCAB术后AF发生的相关危险因素。结果 术后共发生AF 102例,发生率21.79%,多发生于术后1~3 d。AF组年龄、左房内径（LAD）、机械通气时间、P波离散度（Pd）、P波最大时限（Pmax）、高敏肌钙蛋白T（hs-cTnT）、氨基末端B型尿钠肽前体（NT-proBNP）较非AF组高,左室射血分数（LVEF）低于非AF组,差异均有统计学意义（P〈0.05或P〈0.01）。logistic回归分析显示,高龄（≥66岁）、LAD增大（≥38 mm）、LVEF减低（≤40%）、Pd增加（≥39 ms）、Pmax延长（≥110 ms）、hs-cTnT升高（≥0.225 ng/ml）、NT-proBNP升高（≥390.45 pg/ml）、右冠状动脉（RCA）近中段狭窄≥50%是OPCAB术后AF发生的独立危险因素。结论 OPCAB术后AF的发生与高龄（≥66岁）、LAD增大（≥38 mm）、LVEF减低（≤40%）、Pd增加（≥39 ms）、Pmax延长（≥110 ms）、hs-cTnT升高（≥0.225 ng/ml）、NT-proBNP升高（≥390.45 pg/ml）、RCA近中段狭窄≥50%高度相关,可借此预判OPCAB术后AF的发生并指导临床治疗。
Objective To investigate the relative risk factors of atrial fibrillation （AF） in patients after off pump coronary artery bypass grafting （ OPCAB）. Methods The clinical data of 468 cases of OPCAB in the General Hospital of SMAC during January 2014 and June 2014 were retrospectively analyzed. All the patients were divided into AF group and non-AF group according to the postoperative occurrence of AF. Perioperative data of all patients were collected, the risk factors related to the occurrence of AF after OPCAB were screened. Results Postoperative AF occurred in 102 cases （21.79%） , mostly occurred on dl-d3 after surgery. Age, left atrial diameter （LAD） , duration of mechanical ventilation, P wave dispersion （PD）, maximum P wave duration （Pmax）, high-sensitivity troponin T （hs-eYnT）, N-terminal pro-B-type natriuretic peptide precursor （NT proBNP） in AF group were higher than that in non-AF group, but the left ventricular shoot ejection fraction （LVEF） was lower than that in non-AF group, and the differences were statistically significant （P 〈 0.05）. Logistic regression analysis showed that age （ i〉66 years old） , LAD≥38 mm, LVEF≤40% , PD increased （≥39 ms） , prolonged Pmax （≥ 110 ms） , hs-cTnT elevated（ ≥ 0. 225 ng/ml） , NT proBNP ≥ 390.45 pg/ml and the right coronary artery （RCA） proximal and middle stenosis ≥50% are independent risk factors for the occurrence of AF after OPCAB. Conclusion AF occurrence after OPCAB is highly related with age （ ≥66 years old） , LAD≥38 mm , LVEF≤40% , PD increased （ ≥39 ms）, prolonged Pmax （ ≥110 ms） , hs-cTnT elevated（ ≥0. 225 ng/ml） , NT proBNP ≥ 390. 45 pg/ml and RCA proximal and middie stenosis ≥50% , all of which can predict and guide clinical treatment.
出处
《临床误诊误治》
2016年第7期58-63,共6页
Clinical Misdiagnosis & Mistherapy
基金
中国博士后科学基金资助项目(2013M542568)
