摘要
目的探讨心脏瓣膜置换术后发生心律失常的危险因素。方法回顾性分析2017年8月于我院至2019年8月于我院择期在体外循环下行心脏瓣膜置换手术213例患者的临床资料,其中男97例、女116例,平均年龄(53.4±10.5)岁,心功能分级(NYHA)Ⅱ~Ⅳ级。根据术后有无发生心律失常将患者分为术后非心律失常组和术后心律失常组。比较两组临床资料,采用logistic回归模型分析术后发生心律失常的相关危险因素。结果心脏瓣膜置换术后新发心律失常96例(45%),其中术后发生心律失常种类以心房纤颤最为常见(45例,18.44%)。术后心律失常组患者术前心律失常率、心房颤动手术率、术后最低血钾值、血镁值均显著低于术后非心律失常组(P<0.05);低氧血症发生率、高血糖发生率、酸中毒发生率、发热发生率均显著高于术后非心律失常组(P<0.05)。术后发生心律失常的独立危险因素有术后最低血钾值(OR=0.305,95%CI 0.114~0.817)、血镁值(OR=0.021,95%CI 0.002~0.218)、低氧血症(OR=2.490,95%CI 1.045~5.930)。结论术前采取预防措施,术后改善低氧血症,维持电解质平衡和酸碱平衡,监控血糖,尽早发现心律失常并及时处理,可缩短患者ICU停留时间、减少并发症、改善患者预后。
Objective To explore and analyze the risk factors for arrhythmia in patients after heart valve replacement.Methods A retrospective analysis of 213 patients undergoing cardiac valve replacement surgery under cardiopulmonary bypass in our hospital from August 2017 to August 2019 was performed,including 97 males and 116 females,with an average age of 53.4±10.5 year and cardiac function classification(NYHA)grade ofⅡ-Ⅳ.According to the occurrence of postoperative arrhythmia,the patients were divided into a non-postoperative arrhythmia group and a postoperative arrhythmia group.The clinical data of the two groups were compared,and the influencing factors for arrhythmia after heart valve replacement were analyzed by logistic regression analysis.Results There were 96(45%)patients with new arrhythmia after heart valve replacement surgery,and the most common type of arrhythmia was atrial fibrillation(45 patients,18.44%).Preoperative arrhythmia rate,atrial fibrillation operation rate,postoperative minimum blood potassium value,blood magnesium value in the postoperative arrhythmia group were significantly lower than those in the non-postoperative arrhythmia group(P<0.05);hypoxemia incidence,hyperglycemia incidence,acidosis incidence,fever incidence probability were significantly higher than those in the non-postoperative arrhythmia group(P<0.05).The independent risk factors for postoperative arrhythmia were the lowest postoperative serum potassium value(OR=0.305,95%CI 0.114-0.817),serum magnesium value(OR=0.021,95%CI 0.002-0.218),and hypoxemia(OR=2.490,95%CI 1.045-5.930).Conclusion Taking precautions before surgery,improving hypoxemia after surgery,maintaining electrolyte balance and acid-base balance,monitoring blood sugar,detecting arrhythmia as soon as possible and dealing with it in time can shorten the ICU stay time,reduce the occurrence of complications,and improve the prognosis of patients.
作者
严曼榕
钟前进
苟永超
陈建明
胡义杰
宋毅
袁烨
YAN Manrong;ZHONG Qianjin;GOU Yongchao;CHEN Jianming;HU Yijie;SONG Yi;YUAN Ye(Department of Cardiovascular Surgery,Daping Hospital,Army Medical University,Chongqing,400042,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2021年第4期459-466,共8页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
瓣膜置换
心律失常
心房颤动
危险因素
Valve replacement
arrhythmia
atrial fibrillation
risk factors
