摘要
目的分析冠状动脉旁路移植术(CABG)后血乳酸、肌钙蛋白I及C反应蛋白水平对新发房颤的预测价值。方法选取符合纳入及排除标准进行CABG 83例,依据患者术后是否新发房颤分为房颤组(31例)和非房颤组(52例)两组。比较两组一般资料及随访期间不良心血管事件发生情况,对影响CABG后新发房颤发生因素进行多元Logistic回归分析,分析CABG后血乳酸、肌钙蛋白I及C反应蛋白水平对新发房颤预测价值。结果房颤组术前左心室射血分数和术中采用体外循环所占比例低于非房颤组;术后血乳酸、肌钙蛋白I和C反应蛋白水平,术后辅助主动脉内球囊反博、体外肺膜氧合和术后并发低氧血症、术后行气管切开、术后行二次气管插管所占比例,以及住院时间高于或长于非房颤组,差异有统计学意义(P<0.05或P<0.01)。随访期间,房颤组不良心血管事件发生率高于非房颤组,差异具有统计学意义(P<0.01)。多元Logistic回归分析结果显示,术前左心室射血分数<50%、术中行体外循环、术后血乳酸≥2.19 mmol/L、术后肌钙蛋白I≥0.51μg/L以及术后C反应蛋白≥16.31 mg/L是CABG后新发房颤的危险因素(P<0.05或P<0.01)。受试者工作特征曲线分析结果显示,CABG后血乳酸、肌钙蛋白I及C反应蛋白水平预测新发房颤的曲线下面积分别为0.653、0.857和0.758,肌钙蛋白I预测CABG后新发房颤价值优于血乳酸与C反应蛋白水平(P<0.01)。结论CABG后新发房颤患者预后较差,由多种原因导致。CABG后血乳酸、肌钙蛋白I及C反应蛋白水平可预测新发房颤发生。
Objective To analyze the predictive value of blood lactate,TroponinⅠand C-reactive protein(CRP)levels after coronary artery bypass grafting(CABG)in new-onset atrial fibrillation(AF).Methods Eighty-three patients who had undergone CABG and met the inclusion and exclusion criteria were selected.According to the presence or absence of new-onset AF after operation,the patients were divided into AF group(n=31)and non-AF group(n=52).The general data and the occurrence of adverse cardiovascular events during follow-up were compared between the two groups.Multivariate Logistic regression analysis of influencing factors for new-onset AF was performed,and the predictive value of blood lactate acid,TroponinⅠand CRP levels after CABG in new-onset AF was analyzed.Results Preoperative left ventricular ejection fraction and the proportion of intraoperative cardiopulmonary bypass in the AF group were lower than those in the non-AF group,while postoperative blood lactate,TroponinⅠand CRP levels,the proportions of postoperative auxiliary intra-aortic balloon pumping,extracorporeal membrane oxygenation,postoperative hypoxemia,postoperative tracheotomy and postoperative secondary tracheal intubation,and the length of hospital stay were higher/longer than those in the non-AF group(P<0.05 or P<0.01).During the follow-up period,the incidence of adverse cardiovascular events was higher in the AF group than in the non-AF group(P<0.01).Multivariate Logistic regression analysis showed that preoperative left ventricular ejection fraction<50%,intraoperative cardiopulmonary bypass,postoperative blood lactate≥2.19 mmol/L,TroponinⅠ≥0.51μg/L,and CRP levels≥16.31 mg/L were risk factors for new-onset AF in patients undergoing CABG(P<0.05 or P<0.01).Results of receiver operating characteristic curve analysis showed that areas under the curve of postoperative blood lactate,TroponinⅠ,and CRP levels for predicting new-onset AF after CABG were 0.653,0.857,and 0.758,respectively.TroponinⅠwas superior to blood lactate and CRP for predi
作者
李雪
李燕平
王贵华
LI Xue;LI Yan-ping;WANG Gui-hua(Department of Cardiology,the General Hospital of PLA Western Theater Area Command,Chengdu 610000,China)
出处
《临床误诊误治》
2020年第11期59-64,共6页
Clinical Misdiagnosis & Mistherapy
关键词
冠状动脉旁路移植术
房颤
乳酸
肌钙蛋白I
C反应蛋白
Coronary artery bypass grafting
Atrial fibrillation
Lactate acid
TroponinⅠ
C-reactive protein
