高龄冠心病病人非体外循环冠状动脉旁路移植术后心房颤动的临床分析

目的 探讨高龄冠心病病人非体外循环冠状动脉旁路移植术术后心房颤动的相关因素.方法 111例高龄非体外循环冠状动脉旁路移植术,分为心房颤动和无心房颤动两组,回顾性分析冠状动脉病变情况、旁路移植血管的部位及支数、术后电解质变化、循环血容量变化、抗心律失常药物的使用等因素对心房颤动发生率的影响.结果 27例手术后心房颤动,发生率24.3%.在单因素分析中,房颤组病人与非房颤组病人术后中心静脉压、术后血清K+、Mg2+、动脉血SPO2等指标差异有统计学意义,P<0.05.结论 围术期电解质、血氧饱和度、循环血容量改变及发生围术期心梗是高龄病人冠状动脉旁路移植手术后发生心房颤动的危险因素.

Atrial fibrillation in elderly chd patients who underwent off-pump coronary artery bypass grafts surgery

Objective To examine the incidence and risk factors associated with atrial fibrillation in elderly coronary heart disease patients who underwent off-pump coronary artery bypass surgery.Methods From Jun.2008 to Jun.2009,one hundred and eleven patients received OPCAB in our hospital.Clinical data including coronary angiography,diseased vessels,number of bypass grafts,postoperative electrolyte,postoperative hemodynamic measurements,anti-arrhythmic drugs used and other risk factors for atrial fibrillation was collected and reviewed individually.The mean age of patients was(73.19±2.79)years(range from 70 to 82 years).Seventy-nine patients were male and 32 were female.The mean left ventricular ejection fraction(LVEF)was 0.57±0.12,NYHA Ⅰ-Ⅳ.All patients received OPCAB.Saphenous vein(SV)and left internal mammary artery(LIMA)were harvested and used as grafts.LIMA was routinely anastomosed to the left anterior descending artery (LAD),and SV was anastomosed to the other target vessels.The average number of grafts.was(2.79±0.54)per case.The mean operation time was(3.70±0.88)hours and the duration of ICU-staying was(1.32±0.94)days.The patients were divided into 2 groups:atrial fibrillation group and non-atrial fibrillation group.Results Four deaths occurred perioperatively.The mortality was 3.42%.Major postoperative complications included low cardiac output,respiratory dysfunction and acute kidney injury.Twenty seven out of 111 patients who underwent off-pump coronary artery bypass surgery had atrial fibrillation postoperatively.The incidence was 24.3%.Single factor analysis revealed that CVP,serum levels of potassium,magnesium,and SPO2 were lower significantly in atrial fibrillation group than those in the non-atrial fibrillation group,P<0.05.Conclusion Changes of perioperative electrolytes and circulating blood volume,decline in the oxygen saturation,and the occurrence of perioperative myocardial infarction after coronary artery bypass surgery were the risk factors associated with atrial fibrillation.