老年冠心病患者非体外循环冠状动脉旁路移植术后心房颤动的危险因素分析

Analysis of risk factors for postoperative atrial fibrillation in elderly patients with coronary heart disease after off-pump coronary artery bypass grafting surgery

目的 探讨老年冠心病患者非体外循环冠状动脉旁路移植（OPCAB）术后心房颤动的危险因素,为防治OPCAB术后心房颤动提供依据. 方法 选取在我院行OPCAB术的老年冠心病患者139例,依据术后心房颤动情况分为心房颤动组（22例）和非心房颤动组（117例）.对患者一般情况和临床资料进行回顾性分析,探讨导致老年冠心病患者OPCAB术后心房颤动的危险因素.结果 老年冠心病患者OPCAB术后心房颤动的发生率为15.8％.心房颤动组和非心房颤动组性别、糖尿病史、心肌梗死病史、术前应用β受体阻滞剂、冠状动脉病变数、手术时间比较,差异无统计学意义（均P＞0.05）;心房颤动组与非心房颤动组比较年龄大（t=9.960）、左心室射血分数≥40％（χ^2 =4.942）、左房内径≥40 mm（χ^2 =4.491）、高血压史（χ^2=12.357）、术后应用多巴胺（χ^2=8.511）及旁路移植支数≥3支者（χ^2=5.385）较多,差异均有统计学意义（P＜0.05）.Logistic回归分析结果显示,年龄、高血压史、术后应用多巴胺、左房内径和旁路移植支数为老年冠心病患者OPCAB术后导致心房颤动的危险因素（OR=3.080、2.435、2.465、3.593、1.921,均P＜0.05）. 结论 老年冠心病患者OPCAB术后心房颤动的发生率较高,其受多种危险因素的影响,术前可通过这些危险因素评估心房颤动发生情况,以便采取有针对性的防治措施.

Objective To investigate certain risk factors for postoperative atrial fibrillation （AF） in elderly patients with coronary heart disease after off-pump coronary artery bypass grafting （OPCAB）surgery in order to provide a basis for the prevention and treatment of AF after OPCAB.Methods A total of 139 elderly patients with coronary heart disease who had undergone OPCAB surgery in our hospital were collected as research subjects and divided into the AF group and the nonAF group according to the occurrence of AF after operation.The patients＇ general information and clinical data were retrospectively analyzed.Risk factors for AF after OPCAB surgery in elderly patients with coronary heart disease were investigated.Results The incidence of AF after OPCAB was 15.8% in elderly patients with coronary heart disease.There were no statistical differences in gender,history of diabetes,history of myocardial infarction,preoperative β-blocker usage,number of coronary artery lesions,or operation time between the AF group and the non-AF group （P〉0.05）.The percentage of patients who were of older age （t=9.960） or had a left ventricular ejection fraction ≥40% （χ^2=4.942）,a left atrial diameter ≥40 mm （χ^2 =4.491）,a history of hypertension （χ^2 =12.357）,dopamine medication after operation （χ^2 =8.511）,or a bypass vessel count≥ 3 （χ^2 =5.385） was higher in the AF group than in the non-AF group （all P〈0.05）.Logistic regression analysis showed that age,history of hypertension,dopamine medication after operation,left atrial diameter and bypass vessel count were the risk factors for AF after OPCAB surgery in elderly patients with coronary heart disease （OR 3.080,2.435,2.465,3.593,and 1.921,respectively,P〈0.05 for all）.Conclusions The incidence of AF after OPCAB is high in elderly patients with coronary heart disease and is affected by many risk factors.These risk factors should be assessed before surgery so that appropriate prevention measures can be taken.