非心脏开胸术后患者并发心房纤颤相关风险因子评价

Evaluation of risk factors related to atrial fibrillation in patients undergoing noncardiac thoracic surgery

目的探讨非心脏开胸手术后患者并发心房纤颤的病理机制。方法肺切除患者51例,收集其术前基本信息(如合并症、用药状况、心肺功能等),并测定其手术前后血清超敏C-反应蛋白(hs-CRP)和白介素-6(IL-6)水平。结果 AF的发生率为29.4%(15/51),其发生率与年龄因素有关(P=0.031)。发生AF的患者比未发生AF患者术前PR间期延长(P=0.040);使用他汀类药物患者AF发生率明显比未使用者低(P=0.041)。方差分析显示,术后hs-CRP(P=0.000)和IL-6(P=0.000)均与术前存在明显差异。受试者工作曲线(ROC)分析显示:血清hs-CRP和IL-6水平在所观察的3个时间点对预示AF的发生其结果均不理想,曲线下的面积(AUC)均<0.50。结论非心脏开胸手术后患者AF的发生与基础疾病(高血压、糖尿病、冠心病等)、嗜好(如吸烟)和心肺功能等无关,只与年龄有关;早期炎症标记物hs-CRP和IL-6不能预告术后AF发生。某些药物可能会降低非心脏开胸手术后患者AF的发生率。

Objective To investigate the pathological mechanism of atrial fibrillation, in patients after noncardiac thoracic surgery. Methods 51 cases of lung resection in patients, their individual information were collected before surgery. （ such as co- morbidity, medication status, cardiopuhnonary function, etc. ）, and serum high sensitivity C-reactive protein （hs-CRP） and in- terleukin-6 （IL-6） levels were measured before and after surgery. Results The incidence of AF was 29.4% （ 15/51 ）, which was associated with age factor （P = 0. 031 ）. Patients with postoperative AF had a greater PR interval than those without postopera- tive AF （ P = 0. 040）. The occurrence of AF in patients using statins before surgery was significantly lower than that in patients who were not （P =0. 041 ）. Analysis of variance revealed that serum bs-CRP （P =0. 000） and IL-6 （P =0. 000） levels were signifi- cantly different before and after surgery. Receiver operating curve （ROC） analysis showed serum hs-CRP and IL-6 levels were not satisfactory for indicating the occurrence of AF in three time points, all areas under the curve （AUC） were 〈 0. 50. Conclusion AF occurrence was unrelated to underlying diseases （For example, hypertension, diabetes, and coronary heart disease）, Hobhies （such as smoking）, and cardiopulmonary function. Early inflammatory markers hs-CRP and IL-6 did not predict the postopera- tive occurrence of AF. Certain medications may reduce the incidence of postoperative AF undergoning noncardiac thoracic surgery..