P波离散度与动态心电图预测肿瘤术后房颤

Value of P wave dispersion and ambulatory electrocardiogram in predicting atrial fibrillation in patients with the thoracic oncologic

目的探讨P波离散度(Pd)和动态心电图(AECG)预测胸部肿瘤术后心房颤动(AF)的临床价值。方法回顾分析中国医学科学院肿瘤医院ICU2007年1月至2009年12月间术前接受AECG检查的272例胸部肿瘤手术患者的资料,对可能的影响发生房颤的因素进行单因素和多因素Logistic分析。结果除外122例患者,可分析病例150例。AF发生率25.3%(38/150)。多因素分析显示Pd(OR=1.031,95%CI:1.000-1.064,p=0.048)和AECG(OR=8.694,95%CI:3.083-25.514,p<0.001)是AF发生的独立危险因素。Pd预测AF发生的敏感性86.8%,特异性39.3%。术前AECG预测术后AF发生的敏感性44.7%,特异性91.1%。联合应用AECG和P波离散度预测AF发生的敏感性89.5%,特异性39.3%。结论 P波离散度预测胸部肿瘤术后AF发生的敏感性高,术前AECG检查预测的特异性好。

Objective To evaluate the clinical role of P wave dispersion （Pd） and ambulatory electrocardiogram（AECG） in predicting postoperative atrial fibrillation （AF） in patients with thoracic oncologic.Methods Data of consecutive preoperative 272 thoracic oncologic patients who received AECG in surgical intensive care unit （SICU） of Cancer Hospital of Chinese Academy of Medical Sciences during 36-months were retrospectively collected.Univariate and multivariate logistic analysis were conducted for possible influencing factors.Results One hundred and twenty-two patients were excluded and 150 patients were available for review.AF developed in 38 patients （25.3%）.According to univariate analysis,Pd,AECG and pneumonectomy were significant predictors of AF.Multivariate analysis identified two independent predictors of AF： Pd （OR=1.031,95% CI： 1.000 -1.064,p =0.048） and AECG （OR =8.694,95% CI： 3.083 -25.514,p 0.001）.Sensitivity and specificity of Pd in predicting AF is 86.8% and 39.3% respectively,44.7% and 91.1% respectively for AECG,and 89.5% and 39.3% respectively for combined Pd with AECG.Conclusions Pd has high sensitivity in predicting AF and AECG has high specificity for AF.