二尖瓣置换术后新发房颤的围手术期危险因素

Predictors associated with the development of postoperative new-onset atrial fibrillation after mitral valve replacement

目的探讨窦性心律患者行二尖瓣置换术后新发房颤的发生率和围手术期危险因素。方法回顾性分析1998年至2008年行二尖瓣置换术的术前窦性心律患者586例，根据术后是否发生房颤，分为术后房颤组（AF组）和术后窦性心律组（SR组）。纳入评估的危险因素共29个，根据数据类型的不同选用t检验或x^2检验进行单因素分析。单因素分析中P〈0．1的指标进入多因素logistic回归分析。多因素分析中P〈0．05为差异有统计学意义。结果全组中118例发生术后房颤，发生率为20．1％。单因素分析中年龄、慢性肺部疾病、左室质量分数、左心房容积、右心房容积、三尖瓣反流、心功能衰竭、瓣膜病理类型、术后人工二尖瓣有效开口面积指数、术后机械通气时间、术后血清镁浓度及衄清钾浓度等12个危险因素对术后房颤的影响较为显著；多因素分析中年龄、左心房容积、术后人工二尖瓣有效开口面积指数和术后血清钾离子浓度在两组问具有统计学差异。结论年龄、左心房容积、术后人工二尖瓣有效开口面积指数和术后血清钾离子浓度是窦性心律患者二尖瓣置换术后发生房颤的独立危险因素。

Objective To define the incidence and perioperative risk factors of new-onset atrial fibrillation for patients with preoperative sinus rhythm after successful nfitral valve replacement. Methods Retrospective analysis was performed on 586 patients with preoperative sinus rhythm who underwent successful mitral valve replacement in our hospital from 1998 to 2008. The cases were classified into postoperative atrial fibrillation （AF group） or postoperative sinus rhythm （SR group）. Twenty-nine risk factors including clinical and echocardiography data were selected into univariate analysis by using student＇ s t test or chi-squared test according to the data type. The factors with a value of P 〈 0.1 in univariate analysis were assessed by multivariate logistic regression. A value of P 〈 0.05 （two-sided） was considered to be statistically significant in multivariate logistic regression. Results One hundred and eighteen patients had atrial fibrillation postoperatively. The incidence was 20.1%. Univariate analysis revealed that the factors including age, chronic lung disease, left ventricular mass, left atrial volume, right atrial volume, tricuspid valve regurgitation, heart failure, valvular pathology, postoperative prosthetic mitral effective orifice area index, postoperative mechanical ventilation time, serum levels of potassium and magnesium significantly increased the risk of postoperative atrial fibrillation. However, in multivariate logistic regression, age, left atrial volume and postoperative prosthetic mitral valve effective orifice area index and serum of potassium had significant statistically significances between AF group and SR group. Conclusion Age, left atrial volume, postoperative prosthetic valve effective orifice area index and serum of potassium were significant predictors of postoperative new-onset atrial fibrillation for patients with preoperative sinus rhythm after mitral valve replacement.