急性心肌梗死后新发心房颤动患者预后相关因素分析

目的 探讨影响急性心肌梗死合并新发心房颤动(房颤)患者住院期间病死率及转归的因素.方法 回顾性分析我院2011年1月～ 2012年6月急性心肌梗死且行经皮冠状动脉介入术(PCI)病例154例,依据其既往史及住院后心电图分为新发房颤组和非房颤组,分别搜集其冠心病危险因素、心脏彩超的各腔径数据、射血分数、冠脉造影结果、PCI时间、血脂等,并评估CHADS2评分.比较两组住院期间危险因素与新发房颤的相关性、心力衰竭发生率、病死率等.结果 年龄、糖尿病与新发房颤有明确的相关性;CHADS2评分高者多见于新发房颤组;房颤组住院期间病死率及心衰发生率均高于非房颤组;新发房颤好发于前壁心肌梗死,梗死相关动脉多为前降支.结论 心房颤动在心肌梗死患者中不是一种良性心律失常,在临床工作中要充分重视心肌梗死合并新发房颤者,针对危险因素多的重点患者应该在房颤发作前加强预防,更应重视已发作房颤并发症的预防这一关键环节.     

50例肺移植术后心房颤动分析

目的 研究肺移植术后心房颤动（房颤）的发生率与术前相关危险因素.方法 收集无锡市人民医院2002年至2009年50例肺移植患者的临床资料,根据住院期间是否出现房颤持续5 min以上分为房颤组和非房颤组,分析两组患者的超声心动图检查指标及术前一般临床资料.结果 术后13例患者（26.0%）发生房颤,房颤组术前左心房内径（37.38±6.79）mm大于非房颤组中术前左心房内径（32.70±7.22）mm,两者间差异有统计学意义（P＜0.05）.术前左心房内径≥40 mm的患者高于非房颤组[50.0%（8例）对23.5%（8例）,x2=5.329,P=0.021],房颤组与非房颤组在性别、年龄、肺移植种类、原发疾病、术前左心室舒张末内径、肺动脉收缩压、右心房内径、右心室内径、室间隔厚度、左心室后壁厚度、左心室舒张功能之间差异无统计学意义（P＞0.05）.COX分析发现术前左心房内径≥40 mm是肺移植术后发生房颤的独立危险因素,风险系数为4.622.结论 房颤是肺移植术后常见的心律失常,其发生率为26.0%,左心房扩大是肺移植患者术后发生房颤的独立危险因素.     

室上性心动过速射频消融后阵发性心房颤动再发的危险因素分析

目的了解阵发性室上性心动过速(PSVT)合并心房颤动(简称房颤)经射频消融后房颤的复发率,并筛选术后房颤发生的危险因素。方法回顾性分析2002年1月1日至2004年12月31日间PSVT合并房颤住院成功行PSVT射频消融治疗的病人共104例,其中93例随访资料完整,其中男62例、女31例。15例房颤复发为复发组,另78例为无房颤复发组。采用SPSS10.0软件进行统计学分析寻找PSVT病人并发房颤的危险因素。结果随访2.3±0.8年,共有15例(16.1%)术后房颤复发,房颤复发组消融时的年龄、PSVT的病程以及房颤的病程均大于无复发组,而合并器质性心脏病的比例亦高于无复发组。单因素分析表明消融时年龄、合并其它临床疾病、左房内径、房性早搏数目和房性早搏百分比可能是射频术后房颤复发的危险因素,多因素分析表明消融时年龄较大为术后房颤复发的独立的危险因素。结论年龄是PSVT合并房颤患者PSVT消融后房颤再发的高危因素。     

体外循环下冠状动脉旁路移植术后新发房颤的危险因素分析

【摘要】 目的 探讨体外循环下冠状动脉旁路移植（on-pump coronary artery bypass grafting，ONCAB）术后新发房颤的危险因素，为ONCAB术后新发房颤的预防和治疗提供参考。方法 收集我院心脏外科2015年1月至2016年5月间357例单纯ONCAB患者的临床资料，根据术后是否发生新发房颤而分为房颤组和非房颤组。对两组患者围术期的临床参数进行统计分析，从而筛选术后新发房颤的独立危险因素。结果 ONCAB术后新发房颤的发生率为23.8%（85例）。单因素分析结果显示，年龄≥65岁（P=0.02）、慢性阻塞性肺疾病病史（P=0.03）及术前左心房内径≥38 mm（P<0.001）与ONCAB术后新发房颤相关。logistic多因素回归分析显示，年龄≥65岁(OR=1.720, P=0.039)、慢性阻塞性肺疾病病史(OR=11.924, P=0.032)及左心房内径≥38 mm(OR=2.735, P<0.001)是ONCAB术后患者发生新发房颤的独立危险因素。结论 高龄（≥65岁）、慢性阻塞性肺疾病病史及左心房内径增大（≥38 mm）与ONCAB术后新发房颤相关，是潜在的预测因子。     

病态窦房结综合征患者起搏器置入术后发生心力衰竭的随访研究

目的:探讨术前心功能正常的病态窦房结综合征(SSS)患者置入双腔起搏器后心力衰竭的发生情况,并分析相关影响因素。方法:对2001年至2015年大连医科大学附属第一医院确诊为SSS并首次安装双腔起搏器的150例患者进行回顾性研究,记录患者术前基本情况及术后随访结果。终点事件为随访中患者新发心力衰竭。应用Cox比例风险模型评估心力衰竭发生的独立危险因素,应用Kaplan-Meier生存曲线评估累积心力衰竭的发生情况。结果:有145例SSS患者完成随访,平均随访时间为(88±41)个月,91.7%患者的SSS相关症状(头晕、黑曚、晕厥、乏力等)得到改善。随访结束时,35例(24.3%)SSS患者出现心力衰竭。随访1年、3年、5年、10年的新发心力衰竭累积发生率分别为2.8%、10.6%、13.7%、27.2%。高心室起搏百分比(VP%≥50%),术前合并冠状动脉粥样硬化性心脏病、糖尿病、瓣膜病、阵发性房颤,术前左室后壁厚度(LVPWT)是心力衰竭发生的独立危险因素。在35例新发心力衰竭患者中,射血分数保留的心力衰竭(HFpEF)24例(68.6%),射血分数降低的心力衰竭5例(14.3%),射血分数中间值的心力衰竭6例(17.1%)。年龄、术前室间隔厚度(IVST)、术前合并瓣膜病和阵发性房颤是HFpEF发生的独立危险因素。结论:SSS患者起搏器置入术后预后相对较好。新发心力衰竭以HFpEF为主。高VP%、术前LVPWT、术前合并阵发性房颤等基础疾病为SSS患者起搏器置入术后新发心力衰竭的独立危险因素,年龄、术前IVST、术前合并瓣膜病和阵发性房颤为发生HFpEF的独立危险因素。减少不必要的右室起搏及抑制心室重构对患者术后心功能改善至关重要。     

瓣膜置换术后高血糖与新发心房颤动的关系

目的:探讨患者瓣膜置换术后高血糖与新发心房颤动(房颤)的相关性。方法:对我院2017-01-2018-02行瓣膜置换手术的328例患者进行回顾性分析,单因素分析筛选所有患者的新发房颤高危因素,并对有意义的变量进行多因素回归分析。同时分别对糖尿病和非糖尿病患者新发房颤的危险因素进行分析。结果:328例患者中,有118例出现了房颤,发生率为35.98%,单因素分析显示年龄、糖尿病史、左室射血分数(LVEF)、BMI、术后白细胞计数(WBC)、平均血糖值差异有统计学意义(P0.05)。多因素logistic回归分析显示年龄、糖尿病史、BMI、术后WBC及平均血糖值是发生术后房颤的独立危险因素(P0.05)。无论是否合并糖尿病,平均血糖水平均为新发房颤的独立危险因素。结论:患者瓣膜置换术后应激性高血糖是房颤发生的独立危险因素。     

重症监护病房非心脏手术患者术后新发房颤危险因素

目的调查重症监护病房(ICU)非心脏手术患者术后新发房颤(POAF)的发生情况,分析其危险因素及对近期预后的影响。方法采用回顾性、病例配对的方法。在2011年1月至2013年12月期间收住ICU的非心脏手术后成年患者2586例中,筛查术后住院期间新发房颤病例。按照1∶2的比例,选择年龄、性别和手术部位相同的病例作为对照组。采用SPSS 21.0统计软件对数据进行分析。多因素logistic回归分析筛选危险因素。比较2组患者的近期结局。结果 2.7%(71/2586)出现术后新发房颤。高龄(年龄≥75岁)及胸科手术患者术后新发房颤发生率高。在术后新发房颤患者中,77.5%(55/71)出现在术后3 d以内,仅33.8%(24/71)患者有不适主诉。在配对人群中,脓毒症(OR=11.81,95%CI 1.72~81.00,P=0.012)、低钾血症(OR=19.48,95%CI 2.31~164.09,P=0.006)、术后急性充血性心力衰竭(OR=9.91,95%CI1.92~51.22,P=0.006)及新发其他类型心律失常(OR=20.32,95%CI 3.51~117.55,P=0.001)是术后新发房颤的独立危险因素。术后新发房颤伴随机械通气时间及ICU停留时间延长及住院死亡率增高。结论非心脏手术入ICU的患者中术后新发房颤发生率为2.7%,多见于高龄(≥75岁)和胸科手术患者。在病例配对人群中,脓毒症、急性充血性心力衰竭、低钾血症和新发非房颤心律失常是术后新发房颤的危险因素。新发房颤伴随预后恶化。     

心脏再同步治疗术后新发心房颤动与窦性心律的对比分析

目的 分析心脏再同步治疗（CRT）术后1年内慢性心力衰竭（CHF）患者出现新发心房颤动（房颤）与保持窦性心律的疗效对比情况.方法 接受CRT治疗CHF患者54例,所有患者术前均无房颤病史,于术前和术后6、12个月进行程控随访及临床、超声心动图检查.结果 1年随访结束时,54例患者中有12例（22.2%）出现新发房颤,其余42例保持窦性心律.窦性心律组术后临床及超声心动图指标均较术前明显改善（P＜0.001）.新发房颤组术后心功能、左心室射血分数（LVEF）、左心室舒张末内径也较术前有明显改善（P＜0.05）,但左心房内径及二尖瓣反流无明显变化.两组间比较,左心房内径在窦性心律组较新发房颤组有明显缩小的趋势（P=0.057）.亚组分析,阵发性房颤患者术后心功能、LVEF较术前改善（P＜0.05）,而持续性房颤患者术后各指标较术前均无明显变化.CRT术后新发房颤危险因素经Logistic回归显示为术前二尖瓣反流程度（P=0.046,OR=3.729）和新发房颤发生前的心房起搏比例（P=0.010,OR=1.050）.结论 CRT术后新发房颤与二尖瓣反流程度加重和心房起搏比例增高明显相关.新发阵发性房颤一般不影响CRT疗效,新发持续性房颤CRT术后疗效较差.     

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。     

冠状动脉搭桥术后早期室性心律失常分析

对冠状动脉搭桥术后早期室性心律失常的危险因素进行分析。 65例冠状动脉搭桥患者用计算机进行术后 2 4h心电图连续记录 ,并进行回放分析。出现室性心律失常 14例 ,其中 1例心室颤动 ,13例频发室性早搏。对冠状动脉搭桥手术后发生室性心律失常的危险因素进行分析认为 :高龄患者、患者冠脉病变支数、搭桥支数、采取手术方式、术后低血K+为冠脉搭桥手术后心律失常的危险因素。心律失常病人较非心律失常组心胸比较大、手术时心肌阻断时间较长 ,但是无统计学意义。手术前心功能、左室射血分数、左室舒末内径、有无心肌梗塞病史、是否合并高血压、糖尿病、室壁瘤对冠脉搭桥手术后心律失常的影响无统计学意义     

Atrial fibrillation and flutter after coronary artery bypass surgery: epidemiology, risk factors and preventive trials.

Atrial fibrillation and atrial flutter are common arrhythmias after coronary artery bypass grafting. Although the consequences of the arrhythmia are generally not life-threatening, it constitutes a major clinical problem often requiring conversion to sinus rhythm. Atrial fibrillation or flutter can result in hypotension, heart failure, pneumonia, and stroke. This article reviews the literature on epidemiology, electrophysiology, risk factors, and preventive trials. The major conclusions are: (1) In patients undergoing coronary artery bypass surgery, the incidence of postoperative atrial fibrillation or flutter is 20-30%, the peak incidence being on the second or third postoperative day. (2) The strongest independent preoperative predictor for atrial fibrillation or flutter is the patients' age. (3) Intra-atrial conduction delay recorded pre and peroperatively may predict development of atrial fibrillation. (4) Peroperative inducibility of atrial fibrillation by pacing the right atrium may identify patients at risk for postoperative atrial fibrillation. (5) Development of postoperative atrial fibrillation or flutter has not been associated with peroperative or postoperative events. (6) The specificity and sensitivity of age and other possible relevant factors for prediction of atrial fibrillation or flutter after coronary artery bypass grafting is low. (7) No effective prophylactic regimen has yet been established.     

312例非体外循环冠状动脉旁路移植术的危险因素评价

目的：分析与探讨312例非体外循环冠状动脉旁路移植术（OPCAB）危险因素评价的特点，方法：1999年10月－2001年6月连续312例OPCAB手术，死亡7例，通过回顾性分析临床资料，采用没形式的单因素分析法和多元逐步回归分析，筛选出死亡相关的危险因素。结果：急症手术，左心室射血分数，慢性肾功能不全，糖尿病和机械通气时间依次是本组OPCAB手术的死亡相关危险因素，其相对危险度分别是20．718，0．942，19．366，3．821，1．029，年龄，性别，二次手术，心肌梗死1周内属于常规冠状动脉旁路移植术（cCABG)的危险因素不构成OPCAB手术的危险因素，结论：OPCAB手术较cABG手术危险因素减少，体现出OPCAB手术良好的微创效果，但该结果尚有待于大规模多中心的综合评价验证。     

Off-pump coronary artery bypass: analysis of 1080 patients

A consecutive cohort including 1080 patients undergoing "off-pump" myocardial revascularization was reviewed. An average of 2.22 bypass/patients was performed. The death-rate during the first 30 days after surgery was 0.65%. Four cases needed cross-over to on-pump. The postoperative events were: need of inotropic drugs (2.7%), atrial fibrillation (12.4%), myocardial infarction (6.6%). The extubation was performed before the first postoperative 24 h in 91.9% of cases. The majority of patients was discharged from hospital before 8 days after surgery. Off pump coronary artery bypass surgery exhibit good results for most of the patients even if they present multiple vessel disease and high operating risk.     

Left main coronary artery stenosis: factors predicting cardiac events in patients awaiting coronary surgery

Although most patients with left main coronary artery stenosis undergo urgent coronary artery bypass grafting, limited information is available regarding the risk factors that might lead to cardiac events between angiographic diagnosis and surgery. We retrospectively reviewed 1,731 cases of coronary artery bypass grafting at our institution, 97 of which were performed in patients with significant (> or = 50%) left main coronary artery stenosis. These patients were placed in 1 of 2 groups: eventful waiting or uneventful waiting. We analyzed multiple preoperative variables, and the incidence of serious cardiac events (death, myocardial infarction, unstable angina, left ventricular failure, and life-threatening ventricular arrhythmias) during the waiting period between angiography and surgery Four patients (4.1%) experienced serious cardiac events while awaiting surgery (1 had non-ST-elevation myocardial infarction; 3 had life-threatening ventricular arrhythmias); none died. All the events occurred more than 24 hours after cardiac catheterization. Of the preoperative variables analyzed (acute coronary syndrome, age, history of diabetes, hypertension, hyperlipidemia, smoking, renal failure, severity of left main stenosis, right coronary artery involvement, ejection fraction, and use of intra-aortic balloon pump), only acute coronary syndrome predicted the incidence of preoperative cardiac events (P=0.001). The occurrence of severe cardiac events while patients await coronary artery bypass grafting is rare. Carefully selected patients with severe left main coronary artery stenosis can safely await surgery. Concomitant acute coronary syndrome and severe left main coronary artery stenosis indicate a high risk for cardiac events. Therefore, in patients with these conditions, emergency coronary artery bypass may be preferable.     

Ventricular arrhythmias after coronary artery bypass graft surgery: incidence, risk factors and long-term prognosis

The incidence, risk factors and long-term prognosis of complex ventricular arrhythmias after coronary artery bypass graft surgery are not known. Complex ventricular arrhythmias are defined as Lown grades 4a (couplets), 4b (ventricular tachycardia) and 5 (R on T phenomenon). Ninety-two patients with normal left ventricular function who underwent elective coronary artery bypass graft surgery were prospectively evaluated. Ventricular arrhythmias were documented by predischarge 24 hour ambulatory electrocardiographic monitoring; 43% of patients had no or simple ventricular arrhythmias (Lown grades 1 to 3) and 57% had complex ventricular arrhythmias. Risk factors analyzed included age, sex, diabetes, hypertension, smoking, preoperative digoxin or propranolol therapy, cardiopulmonary bypass time, aortic cross-clamp time, number of vessels bypassed, peak creatine kinase (CK) elevation and pericarditis. No risk factor identified patients at higher risk for complex ventricular arrhythmias. Patients were followed up for 6 to 24 months (mean 16). Patients with complex ventricular arrhythmias did not have a higher incidence of sudden death, cardiac death, syncope, angina, myocardial infarction or cerebrovascular accident. It was concluded that: Complex ventricular arrhythmias are common after coronary artery bypass graft surgery. None of the risk factors considered identify high risk patients. Complex ventricular arrhythmias after coronary artery bypass graft surgery do not indicate a poor prognosis in patients with normal left ventricular function.     

Predictors of atrial fibrillation after coronary artery bypass graft： a meta-analysis

Objectives Postoperative atrial fibrillation （AF） has been associated with less favorable outcomes in patients undergoing coronary artery bypass graft surgery （CABG） and may result in increased post-operative morbidity and mortality. A systematic review and meta-analysis of published studies was conducted to examine the risk factors of occurrence AF after CABG. Methods Using the Medline database, the Cochrane clinical trials database and online clinical trial databases, we reviewed all randomized controlled trials （RCTs） and observational studies examining the risk factors of occurrence of AF after CABG. We searched for literature published April 2009 or earlier. Results Our review identified 8 studies （observational studies）, involving 14548 patients, that examined the risk factors of occurrence of AF after CABG. Although studies provide conflicting results, the overall outcomes suggests that advanced age, previous hypertension, numbers of bridge vessels may increase the occurrence of AF after CABG, while no significant difference of diabetes, preoperative myocardial infarction, and preoperative medication of 13 -Blocker have been observed between the AF patients and no-AF patiens. Conclusions Patients with advanced age, previous hypertension and more numbers of bridge vessels had higher risk for the occurrence of AF after CABG, and perioperative medication and care must be intensified to decrease the postoperative occurrence ofAF（J Geriatr Cardio12009; 6：162-167）.     

The impact of new-onset atrial fibrillation on in-hospital mortality following cardiac surgery

BACKGROUND: The impact of new-onset postoperative atrial fibrillation (NAF) on in-hospital mortality (IHM) following cardiac surgery is unknown. METHODS: All patients without preoperative atrial fibrillation undergoing isolated coronary artery bypass graft surgery (CABG) and concomitant CABG and valve surgery were identified (n = 7,347). The association between NAF and IHM was determined using logistic regression modeling. Also, propensity score analysis was used to create two matched subgroups of patients with and without NAF (n = 2,015 in each group). The secondary outcomes examined were stroke, myocardial infarction (MI), intra-aortic balloon pump use, GI complications, deep sternal wound infection (DSWI), septicemia, renal failure, and length of stay. RESULTS: NAF developed in 2,047 patients (27.9%). NAF was not an independent predictor of IHM (odds ratio, 0.8; 95% confidence interval, 0.6 to 1.2; p = 0.3). In multivariate analysis, NAF was associated with age >/= 60 years, combined procedures, preoperative MI within 7 days of surgery, COPD, cerebrovascular disease, and male gender. Propensity-adjusted results revealed no difference in IHM between NAF vs no-NAF patients (2.9% vs 3.5%, respectively; Bonferroni-corrected p = 0.99). However, GI complications (4.2% vs 2.1%), DSWI (1.3% vs 0.4%), septicemia (4.0% vs 1.1%), renal failure (7.6% vs 4.3%), and length of stay (8 days vs 6 days) were significantly increased in patients with NAF. CONCLUSION: NAF following cardiac surgery is not associated with increased IHM.     

CHADS2及CHA2DS2-VASc评分在冠心病外科治疗中的应用

目的：评价CHADS2及CHA2DS2-VASc评分系统在冠心病外科治疗中的意义。 方法：选择2006年1月至2010年1月行不停跳冠状动脉旁路移植术的768个病人,术后新发房颤患者97例,回顾病人的围术期及随访资料,应用CHADS2及CHA2DS2-VASc评分系统,进行分析。 结果：分为术后新发房颤组与非房颤组。术后新发房颤发生率12.6%。平均年龄70.74±8.21岁和65.90±9.83岁,围术期脑卒中8例和9例,CHADS2评分值分别为3.2±1.26和2.13±0.94,CHA2DS2-VASc评分值分别为4.2±1.50和3.23±1.07,CHADS2和CHA2DS2-VASc评分是术后新发房颤的预测因素,与围术期脑卒中显著相关,P < 0.01。 结论：冠心病外科治疗中应用CHADS2及CHA2DS2-VASc评分系统可预测术后新发房颤及围术期脑卒中,对冠心病术后新发房颤的抗凝及抗血小板治疗决策提供了依据,对卒中风险及预后有一定的评估价值。     

Comparison of frequencies of atrial fibrillation after coronary artery bypass grafting with and without the use of cardiopulmonary bypass

This study compared the incidence of postoperative atrial fibrillation in a group of 34 patients undergoing coronary artery bypass graft surgery without the use of cardiopulmonary bypass and cardioplegia with a control group of 747 patients undergoing coronary artery bypass graft surgery using cardiopulmonary bypass and standard cardioplegia. A trend toward a lower incidence of postoperative atrial fibrillation was found in the group that underwent coronary artery bypass graft surgery without the use of cardiopulmonary bypass (n = 0.06).     

主动脉内球囊反搏术在冠状动脉搭桥术后心脏泵衰竭中的应用体会

目的总结主动脉内球囊反搏（IABP）在冠状动脉搭桥术（CABG）后心脏泵衰竭应用的临床经验,探讨此类手术应用IABP的时机选择和适应证。方法总结2007年6月至2012年6月,5例因冠心病行CABG后患者出现心脏泵衰竭,在IABP支持下,术后心功能及血液动力学恢复稳定的情况。结果5例患者均在术后3-7d撤除IABP,恢复良好,痊愈出院。结论冠脉病变严重（多支病变、左主干病变）及急性心肌梗死患者,行冠状动脉搭桥术风险较大,特别是术后出现严重的低心排使手术效果更加不确定。术后应用IABP可以有效地改善心功能,提高手术成功率。