非体外循环冠状动脉旁路移植术后再发脑卒中的危险因素及临床特点

目的探讨非体外循环冠状动脉旁路移植(OPCABG)术后再发脑卒中的危险因素及临床特点。方法选取该院2011年3月至2013年2月收治的156例接受OPCABG的患者,根据患者术后是否发生脑卒中,将所有患者分为卒中组(14例)与对照组(142例),比较两组患者术前与术后的基础临床资料,先进行单因素分析,再对单因素分析有意义的项目进行Logistic多因素回归分析以找出OPCABG后再发脑卒中的危险因素及临床特点。结果卒中组左室射血分数≤50%的患者明显多于对照组(P<0.05);卒中组呼吸机辅助时间>24 h、ICU住院时间>24 h、术后房颤、术后低血压及术后死亡的发生率明显高于对照组(P<0.05);多因素分析结果显示左室射血分数≤50%(β=1.448,OR=4.255)、术后房颤(β=1.728,OR=5.629)、术后低血压(β=1.654,OR=5.228)是OPCABG术后再发脑卒中的独立危险因素。结论左室射血分数≤50%、术后房颤、术后低血压是OPCABG后再发脑卒中的独立危险因素,对于此类患者术前应详细评估,尽可能降低手术的风险。     

有、无体外循环冠状动脉旁路移植术后房颤原因的分析

目的:比较非体外循环下的冠状动脉旁路移植术(OPCABG)与体外循环下的冠状动脉旁路移植术(ECCABG)后房颤的发生率,并分析其原因。方法:OPCABG组75例,手术在全麻常温下进行;ECCABG组113例,手术在全麻低温体外循环下进行。结果:OPCABG组术后15例(20％)出现房颤,ECCABG组术后31例(27.4％)出现房颤。二组房颤发生率有显著差异(P<0.05)。结论:非体外循环下的冠状动脉旁路移植术术后房颤的发生率低于体外循环下的冠状动脉旁路移植术术后的房颤发生率,但仍有较高的发生率。房颤发生的原因可能是术后侧支循环逐渐关闭,改变心房的血液分布,诱发心房内及其周围组织产生局灶激动,从而发生房颤。     

体外循环与非体外循环冠状动脉旁路移植术早期疗效分析

目的:探讨体外循环冠状动脉旁路移植术(CCABG)和非体外循环冠状动脉旁路移植术（OPCABG）早期疗效的差异。方法: 采集自2003年10月~2008年1月我院单纯冠状动脉旁路移植术5325例临床资料,分为CCABG组（343例）与OPCABG组（4 982例）。对两组患者各项术前因素、术中因素、手术死亡率及并发症进行比较。结果: OPCABG组实际手术死亡率（1.7％）明显低于CCABG组（6.7％）,P<0.01;术后二次开胸止血、肾功能不全等并发症的发生率及ICU停留时间、呼吸机辅助时间、术后住院时间都低于CCABG组（P<0.05,P<0.01）。风险调整后CCABG组手术死亡率仍高于OPCABG组6个百分点,术后并发症的发生率均略高于OPCABG组（P<0.05）。结论: CCABG与OPCABG早期临床疗效均令人满意,后者更好一些。     

75岁以上冠心病患者冠状动脉旁路移植疗效分析

目的 探讨高龄患者行冠状动脉旁路移植术(CABG)的安全性及围术期管理。方法 选择2015年1月至2020年10月于山东济宁医学院附属医院接受CABG手术的年龄≥75岁患者112例,其中男性83例,女性29例,年龄75～89（77.2±1.9）岁,根据不同的手术方法,分为对照组（体外循环）和观察组（非体外循环）,对两组患者的术前、围术期并发症及病死率情况进行回顾性分析。结果 两组术前情况、手术时间、桥血管数、病死率对比无显著差异（P>0.05);观察组引流量、围术期输血量低,呼吸机辅助时间、住ICU时间短,并发症少,与对照组差异显著(P<0.05)。结论 高龄患者行CABG安全有效,非体外循环CABG输血量少,并发症发生率低,更利于患者恢复。     

早期营养支持对≥70岁冠状动脉旁路移植术患者的效果分析

目的观察术后早期营养支持对≥70岁冠状动脉旁路移植术患者预后的影响。方法选取2015年6月至2018年12月期间邢台市第三医院≥70岁冠状动脉旁路移植术患者222例,随机分为对照组(n=111)和试验组(n=111),对照组术后仅口服营养,试验组除口服营养外术后第1天开始给予肠外营养进行补充。对两组患者术后总蛋白(total protein,TP)、清蛋白(albumin,ALB)、前清蛋白(prealbumin,PAB)、转铁蛋白(transferrin,TRF)、并发症等方面进行对比分析。结果两组患者术后TP、ALB、PAB、TRF浓度均较术前下降,差异有统计学意义(P<0.05),对照组较试验组下降更明显。两组患者术后第7天TP、ALB浓度比较,差异有统计学意义(P<0.05);术后第3、7天PAB、TRF浓度比较,差异有统计学意义(P<0.05)。试验组术后并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论对≥70岁冠状动脉旁路移植术后患者早期联合肠外、肠内营养支持效果明显优于单纯肠内营养支持,可以有效改善其术后各项营养指标,并降低不良临床结局的发生率。     

胺碘酮联合倍他乐克预防冠状动脉旁路术后房颤

目的研究胺碘酮联合倍他乐克在预防冠状动脉旁路移植(CABG)术后房颤中的作用。方法常规体外循环(CPB)下CABG患者176例随机分为试验组(90例)和对照组(86例)。对照组术前、术后常规服用倍他乐克。试验组倍他乐克用法同上但加用胺碘酮。两组比较CABG术后房颤的发生率。试验终点为术后第30天。结果CABG术后两组比较,试验组房颤发生率(6.7%)小于对照组(22.1%)(P<0.05)。两组内60岁以下患者房颤发生率比较无统计学意义,两组内60岁以上患者房颤发生率比较,差异有统计学意义(P<0.05)。试验组内部<60岁与≥60岁患者房颤发生率比较无区别,而对照组则存在显著差异(P<0.05)。结论胺碘酮联合倍他乐克在预防冠状动脉旁路移植(CABG)术后房颤中的作用优于单用倍他乐克,能进一步降低CABG术后房颤的发生率。尤其对于60岁以上患者效果更加明显。我们推荐60岁以上患者,CABG术后在倍他乐克基础上积极应用胺碘酮,预防房颤的发生。     

门冬氨酸钾镁在预防不停跳冠状动脉旁路移植术后心房纤颤发生的作用

目的:观察门冬氨酸钾镁在预防不停跳冠状动脉旁路移植(OPCABG)术后心房纤颤发生的作用。方法:所有入选160例患者均第1次接受OPCABG,且术前均为窦性心律。将患者随机分为试药组和对照组(每组80例)。试药组为术后3 d每天静脉内输注门冬氨酸钾镁4 g,对照组术后3 d每天输注安慰剂。排除标准:过去存在房颤病史,安装过心脏起搏器,术后心肌梗死,术中改为停跳搭桥的患者,肾功能不全患者。研究终点是术后发生房颤。结果:试药组房颤发生率为9%,对照组房颤发生率为19%,显著高于试药组(P0.01)。试药组ICU停留时间显著短于对照组[(2.6±1.3)d vs.(3.6±1.2)d,P0.05]。结论:术后连续3 d应用门冬氨酸钾镁可以安全有效减少OPCABG术后房颤的发生率。     

75岁以上患者行非体外循环下冠状动脉旁路移植术的临床分析

目的分析年龄≥75岁冠心病患者行非体外循环冠状动脉旁路移植术(OPCABG)的临床资料。方法选择OPCABG的年龄≥75岁的冠心病患者127例,回顾性分析患者ICU时间、术后并发症和病死率等围术期结果。结果127例患者中,2例因术中循环维持困难中转体外循环,余125例均成功实施OPCABG,占98.43%。平均移植桥血管(2.44±1.05)支,术后呼吸机辅助通气时间(30.8±47.7)h,ICU停留时间(57.2±60.3)h,围术期心肌梗死6例,二次手术3例,术后发生肾功能衰竭1例,严重肺部并发症17例,30d内死亡4例,病死率3.1%。82例成功接受随访,随访时间(28.3±12.8)个月,术后2年生存率95.9%,主要不良心脑血管事件发生率8.5%。结论年龄≥75岁冠心病患者行OPCABG安全有效,可作为常规首选术式。     

非体外循环冠状动脉旁路移植术后血制品的应用以及脑梗死危险因素分析

目的:探索非体外循环冠状动脉旁路移植术(OPCABG)术后血制品的应用与脑梗死的关系。方法:收集北京安贞医院住院的301例OPCABG患者术前、术中和术后资料包括输血类型和数量以及脑梗死的发生时间。根据术后是否出现脑梗死,将所有患者分为脑梗死组(n=25)和对照组(n=276)。应用Logistic回归分析OPCABG术后脑梗死的危险因素。结果:脑梗死组左心室射血分数≤50%的患者明显多于对照组;脑梗死组呼吸机辅助时间48h、住院时间、ICU时间、术后低血压的发生率明显高于对照组;脑梗死组输血浆量和输血小板量明显高于对照组,且脑梗死组输血小板的人数明显高于对照组(P0.05)。多因素回归分析结果显示,术后低血压、输血浆以及输血小板是术后脑梗死的危险因素。结论:围术期输血小板或血浆是CABG术后脑梗死的危险因素之一,对于术后出血量多的患者应重点关注患者神经功能的变化并进行对症处理。输血小板和血浆的不良影响机制需要进一步研究。     

70岁以上老年患者冠状动脉旁路移植术临床结果及10年随访分析

目的 观察70岁以上冠状动脉旁路移植术（CABG）患者的特点及术后长期生存状况。方法 回顾性总结分析94例70岁以上（含70岁）CABG患者术前、术中、术后和10年随访资料,并以192例70岁以下CABG患者作为对照组进行比较分析。结果 老年患者;冠脉搭桥术;长期随访①平均远端吻合口数两组无明显差别。②术后气管插管时间、住院时间、肺部感染率和肾功能不全等发生率,≥70岁组显著多于<70岁组。③术后10年随访结果显示≥70岁组左室射血分数（LVEF）值明显低于<70岁组。≥70岁组术后10年LVEF值比术前明显降低。④10年内总病死率、因心脏原因病死率和因心脏以外原因病死率,≥70岁组均显著高于<70岁组。结论 ①≥70岁的患者术后并发症多,康复较长;②高龄患者术后长期生存质量相对较差,病死率也比较高。     

脑梗死患者冠状动脉旁路移植术后神经功能障碍

目的 探讨老年脑梗死患者非体外循环冠状动脉旁路移植术(OPCABG)后神经功能障碍的临床特点.方法 将术前有脑梗死的择期≥60岁的OPCABG患者108例作为研究组,随机择期术前无脑梗死病史≥60岁的OPCABG患者108例作为对照组,对照组手术时间与研究组相近,年龄相差5岁以内,同一组手术医生.结果 研究组术后神经功能障碍发生率明显高于对照组(27.8%与4.6%,OR=6.269,95%CI2.218～17.717,P＜0.01).神经功能障碍表现为谵妄22例及缺血性卒中8例,术后卒中均发生在术后24 h以后;研究组术后ICU时间及住院时间明显长于对照组[分别为(26.5±16.4)h与(21.6±8.8)h,(23.6±9.2)d与(19.4±5.7)d,P＜0.01].结论 在老年非体外循环冠状动脉旁路移植手术患者中,术前具有脑梗死者较无脑梗死者更易发生术后神经功能障碍,如谵妄及卒中,其ICU及住院时间均延长.

Abstract：

Objective To study neurologic injury after off-pump coronary artery bypass grafting (OPCABG) in elder patients with a history of stroke. Methods 108 patients (age≥60years) undergoing elective OPCABG with a history of stroke were studied. Each study patient was matched with 1 control patient who had no stroke history and was undergoing elective OPCABG either immediately before or immediately after the study patients by the same surgeon. Preoperative characteristics, ICU stay, hospital stay, hospital mortality, postoperative neurologic injury were compared in the two groups. Results The incidence of neurologic injury after operation among the study group was higher than those in control group (P＜0.01)(27.8% vs 4.6%). The incidence of delirium and stroke after operation among the study group was higher than those in control group(P＜0.05) (20.4% vs 3.7% ,7.4% vs 0.9%) ;The study group took longer to stay in ICU and hospital than the control group [(26.5±16.4)h vs (21.6±8.8)h ,(23.6±9.2)d vs(19.4±5.7)d, P＜0.01]. Logistic regression analysis showed that the risk factors of neurologic injury after OPCABG included previous stroke (OR 6. 269, 95% CI 2. 218-17. 717), age (OR 1.131,95% CI 1.032-1.239), hypertension (OR 5.072,95% CI 1. 420-18. 114) and diabetes (OR 2. 652,95% CI 1. 123-6. 260). Stroke after the operations was found in 8 of 108 study patients and included cerebral infarction in 6 and transient ischemic attack in 2. 8 patients had late stroke (＞ 24 hours).Conclusion The eldely patients with previous stroke undergoing OPCABG are more likely to have neurologic injury after operations, these patients had longer stays in ICU and hospital.     

高龄患者胰十二指肠切除术分析

目的分析70岁以上老年人胰十二指肠切除术（PD）临床资料并探讨其安全性。方法回顾性分析老年人行PD的临床资料,将90例50岁以上PD手术病例分成≥70岁（高龄组,n＝27）和＜70岁（低龄组,n＝63）两组,分析两组术前Karnofsky功能状态（KPS）评分、入院时血红蛋白（Hb）、血细胞比容（Hct）、血浆白蛋白（ALB）、血清总胆红素（TBIL）、血浆前白蛋白（PALB）、血糖、血钾、手术时间、术中失血量、术后重症监护病房（ICU）入住率、术后住院日、术后并发症发生率及术后死亡率。结果高龄组与低龄组比较,术前KPS评分低[（71.11±6.98） vs （85.40±6.43）,P＜0.01]、血浆ALB低[（34.86±4.54） vs （37.02±4.13）g/L,P＜0.05]、PALB低（127.36±41.19） vs （160.27±57.11）g/L,P＜0.05）、血糖高[（8.47±3.68） vs （6.41±2.12）mmol/L,P＜0.05]、血钾低[（3.38±0.48） vs （3.81±0.45）mmol/L,P＜0.01]、术后ICU入住率高（81.48%vs 39.68%,P＜0.01）,两组间的差异均有统计学意义。两组并发症发生率差异无统计学意义（48.15% vs 39.42%,P＞0.05）。高龄组无住院期间手术死亡,低龄组有2例术后30d内死于并发症。结论严格掌握适应证,重视术前内环境调整,术后积极ICU治疗,≥70岁高龄患者行PD是安全可行的。     

Relation between postoperative mortality and atrial fibrillation before surgical revascularization--3-year follow-up

BACKGROUND: Preoperative atrial fibrillation is one of the predictors of increased morbidity and mortality in patients undergoing surgical revascularization, and consequently, prolongs the duration of stay in the ICU and of overall hospitalization. METHODS: The study included 3000 patients subjected to primary isolated coronary artery bypass grafting from 2000 to 2004. Of the 3000 patients, 5.8 % (n = 174) had electrocardiographically documented, preoperative atrial fibrillation. To evaluate the relationship between preoperative AF and postoperative outcome, all patients were observed for about three years. RESULTS: Patients with preoperative atrial fibrillation were older (P < 0.05), had a lower ejection fraction (P < 0.001), a higher incidence of heart failure (P < 0.001), hypertension (P < 0.001), and more coexistent morbidities including diabetes (P < 0.05), obturative pulmonary disease (P < 0.0001) and mild renal failure (P < 0.001). Statistical analysis showed that survival rates at 6 and 30 days, 6 and 12 months, and 3 years following surgical revascularization of patients with vs. those without preoperative atrial fibrillation were: 96.4% vs. 98.1%, and 94.5% vs. 97.3% (P = ns), 86.2% vs. 93.0% (P < 0.03), and 74.7% vs. 91.0% (P < 0.02), and 70.7% vs. 90.6% (P < 0.01). After 3 years' observation there was a survival difference of 19.9%. We showed that preoperative atrial fibrillation triple increased the risk of postoperative AF and was an independent risk factor for in-hospital death (P < 0.001). CONCLUSIONS: Preoperative atrial fibrillation is a predictor of postoperative complications, including death, and of a significant reduction in patients' long-term survival. Patients with preoperative atrial fibrillation should be considered as high-risk patients with potential postoperative complications and should be well protected with antiarrhythmic and anticoagulant therapy.     

Atrial fibrillation in adults with congenital heart disease following cardiac surgery in a single center: Analysis of incidence and risk factors

Objective: The primary aim of our work is to determine the incidence of atrial fibrillation following cardiac surgery in adults with congenital heart disease. Secondary aims include identifying risk factors predictive of developing early postoperative atrial fibrillation and morbidities associated with early postoperative atrial fibrillation.
Design: Retrospective analysis.
Setting: Single center, quaternary care children’s hospital.
Patients: This review included patients at least 18 years of age with known congenital heart disease who underwent cardiac surgery requiring a median sternotomy at our congenital heart center from January 1, 2012 to December 31, 2016.
Interventions: None.
Outcome Measures: The primary outcome was early postoperative atrial fibrillation. Secondary outcomes included preoperative comorbidities, preoperative echocardiographic findings, operative details, and postoperative morbidities, such length of stay, reintubation, stroke, and death.
Results: The incidence of early postoperative atrial fibrillation was 21%. Those who developed early postoperative atrial fibrillation were older (50 years vs 38 years, P =< .001), had a history of atrial fibrillation prior to surgery, had preoperative pulmonary hypertension, and had longer cardiopulmonary bypass times (103 minutes vs 84 minutes, P = .025) when compared to those who did not develop postoperative atrial fibrillation. Multivariate analysis identified age greater than 60, preoperative pulmonary hypertension, mitral valve intervention, and the need for postoperative inotropic support as being independent predictors of postoperative atrial fibrillation. Those who developed postoperative atrial fibrillation remained in the hospital longer (9 days vs 7 days, P =< .001).
Conclusions: Atrial fibrillation is a common complication following cardiac surgery in adults with congenital heart disease. Age, preoperative comorbidities, type of surgical intervention, and the need for perioperative inotropic infusions may predict the risk of atrial fibrillation in this unique patient population.     

Atrial fibrillation after coronary artery bypass grafting in elderly patients: incidence and risk factor analysis

OBJECTIVE: New-onset atrial fibrillation (AF) is the most frequent arrhythmic complication after coronary artery bypass grafting (CABG). Elderly patients who undergo this operation may have a different risk profile from the general population. The aim of this study was to identify risk factors for post-CABG AF in the elderly population. METHODS: Between September 2001 and December 2005, 426 elderly patients (age >/= 65 years) underwent CABG at our center. Ninety-one developed post-CABG AF (AF group), and the other 335 (no-AF group) did not develop this complication. Multivariate analysis (odds ratio, +/- 95 % CI, P value) was used to identify independent clinical predictors of post-CABG AF. RESULTS: The incidence of post-CABG AF in elderly patients during the study period was 21.4 %. Multivariate analysis identified age (OR 1.07, P < 0.009), age >/= 75 years (OR 1.77, P < 0.042), preoperative renal insufficiency (OR 5.09, P < 0.035), EuroSCORE (OR 1.18, P < 0.038), and cross-clamping time (OR 1.02, P < 0.012) as predictors of AF occurrence. The AF group had a significantly longer mean intensive care unit (ICU) stay (3.8 +/- 4.7 vs. 2.5 +/- 1.3 days for AF vs. no-AF; P = 0.0001), and a significantly higher proportion of patients with prolonged (>/= 6 days) ICU stays (8.8 % vs. 3.2 %, respectively; P = 0.033). Hospital mortality was 3.2 % in the no-AF group and 2.2 % in the AF group ( P = 0.74). CONCLUSION: This study of elderly patients reveals some novel predictors of post-CABG AF, most notably preoperative renal insufficiency and EuroSCORE. It is important to identify risk factors for post-CABG AF in all patient groups as this knowledge might lead to better prevention of this problem and its potential consequences.     

Warfarin for stroke prevention in octogenarians with atrial fibrillation

The authors examined warfarin use in elderly patients with atrial fibrillation. Medical records were abstracted from a random sample of Medicare beneficiaries with atrial fibrillation who were discharged from Kansas hospitals. Data were analyzed for warfarin and aspirin use and risk factors for stroke or bleeding in patients 65–79 years of age or 80 years and older. Stroke risk factors other than age and atrial fibrillation were seen in 98% of 142 patients less than 80 years of age and 100% of 141 octogenarians. Warfarin use was similar in the younger and older age groups (50% vs. 45%, respectively; p= ns) and was not associated with the number of stroke or bleeding risk factors. Compared to patients less than 80 years of age, octogenarians were less likely to receive aspirin (38% vs. 27%, respectively; p< 0.05). Anticoagulation rates for high-risk patients with atrial fibrillation were low and poorly explained by stroke or bleeding risks.     

左心房内径与高龄心房颤动并缺血性卒中的相关性分析

目的 左心房内径与高龄心房颤动并缺血性卒中的相关性。方法 选取2015.01~2018.08在南部战区总医院干部病房住院的高龄患者共524例,房颤患者264例,其中持续性房颤132例(25.2%),阵发性房颤132例(25.2%),非房颤患者260例(49.6%)。通过病历资料,调取超声心动图检查结果,比较左心房内径在房颤组与非房颤组之间、房颤卒中组与非房颤卒中组之间是否存在差异。结果 与非房颤组相比,房颤组左心房左右内径(43.87±8.20mm vs 38.06±4.50mm, P=0.001)、左心房前后内径(37.96±7.24mm vs 33.54±4.51mm, P=0.001)、左心房上下内径(44.98±7.25mm vs 43.00±7.59mm, P=0.001)、右心房前后内径(53.09±6.65mm vs 48.71±7.14mm, P=0.001)、肌酐(124.42±88.20umol/L vs 110.01±48.39umol/L, P=0.023)、胱抑素C(1.97±1.22mgl/L vs 1.63±0.62mgl/L, P=0.001)、尿酸(400.13±121.34umol/L vs 378.71±118.47umol/L, P=0.043)、同型半胱氨酸(16.80±11.58umol/L vs 14.87±5.84umol/L, P=0.017)、低密度脂蛋白(1.79±0.65mmol/L vs 2.01±0.76mmol/L, P=0.001)、甘油三酯(3.38±0.88mmol/L vs 3.66±0.99mmol/L, P=0.001)、缺血性卒中(136/128 vs 78/182, P=0.001)、慢性心力衰竭(141/123 vs 69/191, P=0.001)等指标在两组之间差异有统计学意义。房颤卒中组尿酸(385.65±122.37umol/L vs 415.28±118.83umol/L, P=0.047)、左心房左右内径(44.71±7.83mm vs 42.72±8.47mm, P=0.049)、左心房上下内径(45.45±6.87mm vs 43.18±7.69mm, P=0.012)、慢性心力衰竭(81/55 vs 60/68, P=0.048)等指标与非房颤卒中组比较,差异有统计学意义。通过Logistic回归分析发现,左心房左右内径、左心房上下径、慢性心力衰竭可能与高龄房颤并缺血性卒中存在关联性,左心房左右内径、左心房上下径可作为高龄房颤并缺血性卒中的预测因子,ROC曲线下面积分别为0.596、0.588。结论 左心房内径不仅与高龄房颤并发缺血性卒中存在关联性,也可作为高龄房颤并发缺血性卒中的预测因子。     

小剂量口服胺碘酮在心脏瓣膜疾病合并心房颤动患者围术期的应用

目的 评估围术期口服胺碘酮对心脏瓣膜疾病合并心房颤动患者术后心房颤动心律的转复和窦性心律维持,以及术后并发症的影响.方法 78例心房颤动且择期行心脏瓣膜手术的患者被分为试验组（38例）和对照组（38例）.试验组开始口服胺碘酮每天2次,每次200 mg至术后第3天,术后第4天至出院前胺碘酮剂量改为每天1次,每次200 mg.对照组以安慰剂代替胺碘酮,服药时间、剂量和方法同实验组.比较两组术后窦性心律的转复和维持、有无低心排血量综合征、心律失常发生及类型、重症监护病房停留时间、住院时间、出院时心房颤动患者的心律和心室率,及术前、术后患者肝功能、甲状腺功能的变化,有无发生肺纤维化.结果 术后两组比较,试验组窦性心律患者比例在手术复跳时（39.4％ vs.10.5％,P＜0.01）、出院前（46.7％ vs.2.6％,P＜0.01）及术后1个月（36.8％ vs.2.6％,P＜0.01）均高于对照组,差异有统计学意义.试验组与对照组比较,术后快速性心房颤动（15.8％ vs.31.6％,P＜0.05）、发作时心室率[（136.5±25.2）次/min vs.（158.6±30.9）次/min,P＜0.05]及室性心律失常（7.9％ vs.18.4％,P＜0.05）低于对照组,差异有统计学意义.试验组重症监护病房停留时间[（40.9±11.2）hvs.（58.5±13.8）h,P＜0.05）]、心房颤动患者出院时心室率[（74.2±8.4）次/min vs.（91.7±10.2）次/min,P＜0.05]均小于对照组,差异有统计学意义.两组患者术后无死亡,无肝功能及甲状腺功能异常及无肺纤维化.结论 行心脏瓣膜置换或整形手术的心房颤动患者围术期口服胺碘酮可明显提高患者术后窦性心律转复率、维持窦性心律时间、降低快速心房颤动及室性心律失常发生率,对心室率的控制满意,减少重症监护病房入住时间,无明显不良反应.     

单次胺碘酮预防男性急诊体外循环冠状动脉旁路移植术后心房颤动的疗效评价

目的:探讨单次应用胺碘酮对男性患者行急诊体外循环冠状动脉旁路移植术(ONCABG)后新发心房颤动预防的疗效.方法:50例美国麻醉医师协会(ASA)患者全身状况分级III-IV级急诊行ONCABG的男性患者,均伴有高血压和2型糖尿病病史。随机分为试验组(Y组,n=25)和对照组(C组,n=25)。Y组和C组分别在升主动脉开放前经中心静脉注入0.9%氯化钠液20mL和胺碘酮注射液20mL(3mg/kg)。结果:Y组和C组的术后心房颤动发生率(28%vs.24%),胺碘酮转复率(100%vs.100%),差异无统计学意义,但是多元线性回归显示体外循环时间和术后发生心房颤动会影响患者ICU入住时间(P0.05)。结论:单次静脉预防性应用胺碘酮并不能降低男性患者急诊ONCABG术后心房颤动的发生率;长时间体外循环和术后新发心房颤动是延长患者ICU入住时间的独立危险因素。     

Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in the elderly

Introduction: The number of elderly patients with atrial fibrillation (AF) is increasing rapidly, and the safety and efficacy of catheter ablation in this demographic group has not been established. Methods: Over a 7‐year period we studied 1,165 consecutive patients undergoing 1,506 AF ablation procedures using a consistent ablation protocol that included proximal ostial pulmonary vein (PV) isolation and focal ablation of non‐PV AF triggers. Outcome was analyzed for three distinct age groups: <65 years (group 1; n = 948 patients), 65–74 years (group 2; n = 185 patients), and ≥75 years (group 3; n = 32 patients) based on the age at the initial procedure. Results: There was no significant difference in AF control (89% in group 1, 84% in group 2, and 86% in group 3, P = NS) during a mean follow‐up of 27 months. Major complication rates were also comparable (1.6% in group 1, 1.7% in group 2, 2.9% in group 3, P = NS) between the three groups. There was no difference in the left atrial size, percentage with left ventricular ejection fraction <50%, or percentage with paroxysmal versus more persistent forms of atrial fibrillation. However, older patients were more likely to be women (20% in group 1, 34% in group 2, and 56% in group 3, P < 0.001) and have hypertension and/or structural heart disease (56% in group 1 vs 68% in group 2 vs 88% in group 3; P < 0.001). There was a strong trend demonstrating that older patients were less likely to undergo repeat ablation (26% vs 27% vs 9%) to achieve AF control and more likely to remain on antiarrhythmic drugs (20% vs 29% vs 37%; P < 0.05). Conclusions: Elderly patients with AF undergoing catheter ablation therapy are represented by a higher proportion of women and have a higher incidence of hypertension/structural heart disease. To achieve a similar level of AF control, there appears to be no increased risk from the ablation procedure, but elderly patients are more likely to remain on antiarrhythmic drugs.