冠状动脉旁路移植术后早期心房颤动的相关因素分析

Analysis of predictors of atrial fibrillation early following coronary artery bypass grafting surgery

目的分析冠状动脉旁路移植(CABG)术后早期心房颤动(AF)发生的相关因素,为探讨其相应的防治措施提供依据。方法回顾性总结2002年3月至2007年10月间住院手术治疗的单纯CABG病例101例,按术后有否发生AF进行分组,并分别对术前、术中和术后资料进行统计和分析。统计学分析采用独立样本t检验和χ2检验。结果 CABG术后早期AF的发生率为21.8%(22/101),两组比较,AF组平均年龄、体外循环时间和主动脉阻断时间、辅助呼吸时间、术后胸腔引流总量均明显大于非AF组,有显著性差异(P<0.05);RCA近-中段狭窄>50%的患者AF的发生率高达81.8%。性别、心肌梗死史、高血压病史、糖尿病史、LVEF大小和应用洋地黄类药物与否在两组间无统计学意义(P>0.05)。结论 CABG术后AF的发生率为21.8%,77.3%发生在术后1～3d内。CABG术后AF是多因素造成的,其中一些重要的因素包括:年龄、体外循环时间、辅助呼吸时间、术后胸腔引流总量。RCA近-中段狭窄>50%为独立危险因素。术前存在AF的患者术后依旧存在AF。采用OPCAB手术方式的患者术后AF的发生率低于CCABG。

Objective To analyse the clinical predictors of atrial fibrillation（AF） early after coronary artery bypass grafting（CABG）,and provide evidence for prevention and treatment.Methods 101 consecutive patients underwent isolated CABG procedure from Mar.1998 to Oct.2002 were retrospective analyzed.The patients were grouped according to whether AF appeared after CABG.were analyzed to identify the predictors for postoperative AF.Independent-Samples T Test and Chi-Square Test were used for statistic analysis.Results The overall incidence of postoperative AF was 21.8%（22 /101）,19（77.3% ） appeared during 1 ～ 3 days after operation,2 in 4 ～7 days,and 1 more than 7 days.The average age,CPB and aortic clamping time,mechanicalventilation time,total volume of chest drainage 3 days after operation of AF group were more than those of nonAF group（P〈0.05）;Incidence of AF in patients with stenosis surpass 50 percent in proximal and median segments of RCA is 81.8% .There were no statistic significances between the two groups as for gender,history of myocardial infarction,high blood pressure,diabetes mellitus,LVEF,or whether digitalis was used.Conclusion Incidence of AF after CABG is 21.8%,77.3% appeared during the 1 ～ 3 days after operation.Many factors associated with AF after CABG,some important ones were age,CPB and aortic clamping time,mechanical ventilation time,total volume of chest drainage 3 days after operation.Stenosis surpass 50 percent in proximal and median segments of RCA is an independent risk factor.Preoperative AF patients maintain AF after CABG.Incidence of AF in OPCAB is lower than that in CCABG.