非心脏手术后危重患者新发心房颤动的临床分析(附71例报告)

Analysis of postoperative new-onset atrial fibrillation in critically ill patients undergoing noncardiac surgery

目的探讨危重患者非心脏手术后新发房颤情况,并分析其相关影响因素。方法回顾性分析2011年1月-2013年12月行非心脏手术后入住北京大学第一医院重症监护病房、年龄≥18岁、术后14d内出现心房颤动患者的临床资料。结果纳入术后14d内出现新发心房颤动的患者71例,占同期非心脏手术后入住重症监护病房患者的2.7%（71/2586）,且随年龄增长新发房颤发生率逐渐增高。胸科患者术后新发房颤的发生率为6.1%,明显高于非胸科患者（2.4%,P=0.001）;急诊手术患者术后新发房颤的发生率为8.1%,明显高于择期手术患者（2.1%,P〈0.001）。慢性病因的前三位分别为高血压（57.8%）、冠心病（26.8%）和糖尿病（12.7%）,急性病因的前五位分别为急性贫血（76.1%）、急性心肌缺血（46.5%）、急性心衰（43.7%）、电解质异常（45.1%）及严重感染（38.0%）。术后新发房颤的首次发作时间呈现双峰（手术当天及术后第2~3天）,首次发作的持续时间为254.5±112.5min。71例术后新发房颤患者中,95.8%（68/71）转复为窦性心律,其中自行转复和药物转复分别占7.3%（5/68）和80.9%（55/68）,二者兼有的占11.8%（8/68）。93.0%（66/71）的术后新发房颤患者接受了胺碘酮治疗。术后新发房颤患者的30d死亡率为8.5%（6/71）,为同期该监护病房术后患者30d死亡率（2.5%）的3.4倍。结论非心脏手术后危重患者新发房颤的发生率高于一般人群,并随年龄增长而增高。在非心脏手术后危重患者中应重视高龄及手术相关的急性病因,警惕房颤的发生。

Objective To determine the incidence of postoperative new-onset atrial fibrillation（NAF） in critically ill patients undergoing non-cardiac surger y, and to analyze the factors associated with atrial fibrillation. Methods This was an observational study. The clinical data of adult patients, age ≥18 years suffering from atrial fibrillation, with in 14 days after noncardiac surger y, who were admitted to the intensive care unit（ICU） of Peking University First Hospital from Januar y 2011 to December 2013, were analyzed. Results There were 71（2.7%） patients suffering from NAF during 14 days after an operation, and the incidence became higher with age. Incidence rate of NAF was 6.1% in patients undergone thoracic operations, which was significantly higher than that in non-thoracic surgery patients（P=0.001）, and the incidence rate of NAF in patients with emergency operation was 8.1%, which was significantly higher than that in the patients undergone selective surger y（P〈0.001）. The first three factors associated with chronic diseases were hypertension（57.8%）, coronary heart disease（26.8%）, and diabetes（12.7%）, and the first five factors associated with acute diseases were acute anemia（76.06%）, acute myocardial ischemia（46.5%）, acute heart failure（43.7%）, electrolyte abnormalities（45.1%）, and severe infection（38.0%）. The time of onset of postoperative NAF presented a double peak（surgical day and the 2nd-3rd day after surgery）, and the duration of initial onset was 254.5±112.5min. Following the new-onset of atrial fibrillation, in 95%（68/71） of the patients it returned to sinus rhythm, among whom 7.3%（5/68） was spontaneous, 80.9%（55/68） drug-induced, and 11.8%（8/68） combination of both the conversions. In 93.0%（66/71） of postoperative NAF patients amiodarone therapy was given. The 30-day mortality rate was 8.5%（6/71）, which was 3.4 times that of the postoperative patients in the same ICU at the same period. Conclusions The incidence of postoperative NAF is higher in critically ill patients than in non-critical patients. The incidence rate increases with age. We should pay more attention to the critically ill patients of advanced age, and morbid factors associated with operations.