摘要
目的探索接受冠状动脉旁路移植术(CABG)患者术后心房颤动(POAF)的影响因素。方法本研究为单中心病例对照研究。连续选取2017年12月20日至2020年12月23日在中山大学孙逸仙纪念医院心外科行CABG的168例患者。根据出院前有无POAF分为POAF组(40例)和无POAF组(128例)。收集患者的基线资料、围手术期实验室检查指标、彩色超声心动图指标、手术相关数据。通过Logistic回归分析寻找影响因素;使用受试者工作特征(ROC)曲线分析获得截断值;使用Kaplan-Meier检验进行生存分析,Log-rank检验比较生存率差异。结果患者中位年龄64.0(55.0,69.0)岁,其中男134例(79.8%,134/168)。中位随访时间为术后16.0(9.0,24.0)d。与无POAF组相比,POAF组的术前N末端脑钠肽前体[799.9(280.4,1980.5)pg/ml对389.2(97.4,1146.5)pg/ml,P=0.021]、术前肌酸激酶同工酶[14.0(12.3,19.8)U/L对13.0(11.0,16.5)U/L,P=0.036]水平较高,差异有统计学意义;术前甘油三酯[TG,1.33(0.99,1.87)mmol/L对1.63(1.24,2.27)mmol/L,P=0.011]、术前左心室射血分数[54.0(41.3,63.0)%对60.0(50.0,68.0)%,P=0.016]、术后血红蛋白[Hb,(90.80±12.15)g/L对(97.55±15.12)g/L,P=0.011]水平较低,差异有统计学意义;重症监护病房停留时间[5.0(3.0,8.0)d对4.0(3.0,5.0)d,P=0.021]、术后住院时间[24.0(17.0,33.5)d对17.0(13.0,23.0)d,P<0.001]、总住院时间[24.0(17.0,35.0)d对20.0(14.3,26.0)d,P=0.008]均延长,总治疗费用[19.1(15.4,26.1)万元对16.0(12.1,19.4)万元,P<0.001]增加,差异有统计学意义。多自变量Logistic回归分析发现,术前TG(OR=0.368,95%CI 0.174~0.779,P=0.009)、术后Hb(OR=0.959,95%CI 0.928~0.991,P=0.013)可能是CABG-POAF的重要影响因素。通过ROC曲线分析所得术前TG的截断值为1.14 mmol/L,术后Hb的截断值为98.50 g/L。分别基于术前TG、术后Hb的截断值对入组患者进行分组,Kaplan-Meier法分析显示,术前TG≥1.14 mmol/L组和术前TG<1.14 mmol/L组的平均无POAF生存时间分别为43 d和27 d;术后Hb≥98.
Objective To explore the influencing factors of postoperative atrial fibrillation(POAF)after coronary artery bypass grafting(CABG).Methods This was a case-control study.Consecutive 168 patients underwent CABG in the Department of Cardiovascular Surgery,Sun Yat-sen Memorial Hospital from December 20,2017 to December 23,2020,were retrospectively analyzed.The end point was POAF before discharge.The patients were divided into two groups:POAF group including 40 cases,non-POAF group including 128 cases.The data including perioperative laboratory examination,echocardiography results,surgical data were analyzed using SPSS 20.0 software.Influencing factors of POAF were screened with multivariate Logistic regression analysis.The cutoff values were obtained by performing the receiver operator characteristics(ROC)curve analysis.Survival curves were conducted with the Kaplan-Meier method and compared by the Log-rank tests.Results The median age was 64.0(55.0,69.0)years.One hundred and thirty-four males(79.8%,134/168)were included.The median follow-up time was 16.0(9.0,24.0)d.Compared with the non-POAF group,patients in the POAF group were with higher level of preoperative N-terminal pro-brain natriuretic peptide[799.9(280.4,1980.5)pg/ml vs.389.2(97.4,1146.5)pg/ml,P=0.021]and preoperative creatine kinase-myocardiol band[14.0(12.3,19.8)U/L vs.13.0(11.0,16.5)U/L,P=0.036];while the level of preoperative triglyceride[TG,1.33(0.99,1.87)mmol/L vs.1.63(1.24,2.27)mmol/L,P=0.011],preoperative left ventricular ejection fraction[54.0(41.3,63.0)%vs.60.0(50.0,68.0)%,P=0.016]and postoperative hemoglobin[Hb,(90.80±12.15)g/L vs.(97.55±15.12)g/L,P=0.011]were significantly lower.Intensive care unit(ICU)stay[5.0(3.0,8.0)days vs.4.0(3.0,5.0)days,P=0.021],postoperative hospital stay[24.0(17.0,33.5)days vs.17.0(13.0,23.0)days,P<0.001]and total hospital stay[24.0(17.0,35.0)days vs.20.0(14.3,26.0)days,P=0.008]in POAF group were comparably longer.Naturally,medical expenses were higher[0.19(0.15,0.26)million yuan vs.0.16(0.12,0.19)million yuan,P<0.00
作者
梁淑敏
黄丽历
麦碧芳
谢双伦
Liang Shumin;Huang Lili;Mai Bifang;Xie Shuanglun(Department of General Practice,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China;Department of Cardiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)
出处
《中华心律失常学杂志》
2024年第5期396-405,共10页
Chinese Journal of Cardiac Arrhythmias
基金
国家自然科学基金(82070412)。
关键词
心房颤动
冠状动脉旁路移植术
甘油三酯
血红蛋白
围手术期
Atrial fibrillation
Coronary artery bypass grafting
Triglyceride
Hemoglobin
Perioperative period
