非体外循环下冠状动脉旁路移植术后新发心房纤颤的相关危险因素分析

目的探讨非体外循环下行冠状动脉旁路移植手术患者在术后住院期间新发心房纤颤的发病特点并对相关的危险因素进行分析。方法回顾2010年1月—2011年6月910例在我院心外科非体外循环下行冠状动脉旁路移植术的患者,监测术后患者的心电示波、心电图,分析患者性别、年龄、病史、术前用药、术前B型钠尿肽水平、肌酐水平、冠状动脉病变情况、超声心动图显示的左房径、左室舒张末期内径、射血分数、术中静脉桥及动脉桥的支数、术后机械通气时间、术后4 h肌钙蛋白Ⅰ水平,观察上述因素与患者术后住院期间新发心房纤颤的关系。结果在910例冠状动脉旁路移植术患者中,术后住院期间新发心房纤颤154例,发生率16.9%。单因素分析结果显示:年龄(P=0.016)、术前最后一次B型脑钠肽水平(P=0.002)、静脉桥数(P=0.015)和桥血管数/病变血管数(P<0.001)与冠状动脉旁路移植术后的新发心房纤颤相关,P<0.05的相关危险因素进入二元Logistic回归分析,结果显示:年龄(OR=1.087)、术前最后一次B型脑钠肽水平(OR=1.002)、桥血管数/病变血管数(OR=0.042)与术后新发心房纤颤独立相关。以B型脑钠肽水平作ROC曲线,曲线下面积0.670,说明术前最后一次B型脑钠肽水平对于术后新发心房纤颤具有中度的预测价值。结论冠状动脉旁路移植术后新发心房纤颤原因较多,高龄、术前最后一次B型脑钠肽水平高和患者的再血管化程度不完全是术后新发心房纤颤的独立危险因素,而B型脑钠肽水平对术后新发心房纤颤具有中度的预测价值。

Risk Factors for New-Onset Atrial Fibrillation after Off-Pump Coronary Artery bypass Grafting Surgery in the Early Post-Operative Phase

Objective To evaluate the clinical risk factors for new-onset atrial fibrillation after off-pump coronary artery bypass grafting(CABG) surgery in the early post-operative phase.Methods The clinical data of 910 patients who underwent off-pump CABG between January 2010 and June 2011 were retrospectively analyzed.Parameters including age,gender,medical history,preoperative drugs,preoperative B-type natriuretic peptide(BNP) levels,creatinine level,heart function,left atrial diameter,severity of coronary artery stenosis,vein and arterial grafts in surgery,duration of mechanical ventilation after surgery,and postoperative troponin I level were recorded.The relationship of these parameters with the new-onset atrial fibrillation after operation were analyzed.Results Atrial fibrillation occurred in 154 patients(16.6%) after off-pump CABG.Univariate analysis showed that age(P=0.016),the preoperative BNP levels(P=0.002),the number of vein grafts(P=0.015),and numbers of grafts/numbers of lesion(P<0.001)were significantly correlated with the new-onset atrial fibrillation after off-pump CABG.Binary Logistic regression analysis showed that age(OR=1.087),BNP levels(OR=1.002),and numbers of grafts/numbers of lesion(OR=0.042)were independently correlated to the incidence of postoperative atrial fibrillation.The receiver operating characteristic(ROC)curve demonstrated that the preoperative BNP level was a predictor of postoperative atrial fibrillation,with an area of 0.670 under the ROC curve.Conclusions Many factors are involved in the new-onset artial fibrillation after off-pump CABG,among which older age,higher BNP levels before operation,and incomplete revascularization are the independent risk factors.BNP level can serve as a moderate predictor for postoperative new-onset atrial fibrillation.