冠状动脉旁路移植术后早期血压波动对恶性心律失常发生的预测价值

Predictive value of early blood pressure fluctuations after coronary artery bypass grafting in the occurrence of malignant arrhythmias

目的评估冠脉搭桥术后早期血压波动对恶性心律失常发生的预测价值，以期为术后监护与病情评估提供现实依据。方法以方便抽样的原则选取2017年3-8月于南京医科大学附属南京医院心胸外科行冠状动脉旁路移植术的患者120例，根据患者术后住院期间是否发生恶性心律失常将其分为2组。收集一般资料、实验室资料及术后24h血压值（每15min记录一次），采用平均真实波动性法（ARV）评价术后24h收缩压（SB）和舒张压（DB）的波动情况。结果术后共有31例（25．83％）患者发生恶性心律失常，房颤21例（17．5％）、房性早搏3例（2．5％）、室性早搏6例（5．0％）、室颤3例（2．5％）、室速3例（2．5％）、室上性心动过速2例（1．7％）。独立样本t检验显示，恶性心律失常组术后24h平均收缩压值（SBAVE）、平均舒张压值（DBAVE）、收缩压波动值（SBARV）、舒张压波动值（DBARV）均大于无恶性心律失常发生组（P〈0．01）。Logistic回归分析结果显示，除年龄（OR=1．162）、机械通气时间以外（OR=1．174），术后24h SBARV、DBARV也可以预测术后恶性心律失常的发生，且SBARV的预测能力更强（SBARVOR=2．92，DBARVOR=1．941）。结论SBARV值、DBARV值能预测冠状动脉旁路移植术后恶性心律失常的发生，且SBARV的预测能力更强。应重视术后24h血压的波动情况，维持术后血压的稳定性。

Objective To investigate the blood pressure variability in early stage after coronary artery bypass grafting, and to evaluate the predictive value of blood pressure variability in the occurrence of malignant arrhythmia, so as to provide a practical basis for postoperative monitoring and disease evaluation. Methods A total of 120 patients undergoing coronary artery bypass grafting from March 2017 to August in cardiothoracic surgery of a third grade hospital were selected under the principle of convenient sampling, 120 patients were divided into two groups according to whether or not the malignant arrhythmia occurred after operation; general data, laboratory data and blood pressure values 24 hours after surgery were collected. The fluctuation of systolic blood pressure （SB） and diastolic blood pressure（DB） was assessed by mean real fluctuation（ARV）. Results A total of 31 cases（25.83%） of malignant arrhythmia, including 21 cases（17.5%） of atrial fibrillation, 3 cases（2.5%） of atrial premature beat, 3cases（5%） of ventricular premature beat, 6 cases of ventricular fibrillation in 3 cases（2.5%）, 3 cases（2.5%） of ventricular tachycardia, supraventricular tachycardia 2 cases（ 1.7% ） ; malignant arrhythmia group SBAVE and DBAw; 24 hours of total SBARV and DBARV values were greater than the non malignant arrhythmia group （P〈0.01）. The re- suits of Logistic regression analysis showed that SBARV and DBARV could predict the occurrence of malignant arrhythmia after operation 72 hours, and except the age （OR=1.162） and mechanical ventilation time （OR=1.174）,SBARV and DBARV can also predict the occurrence of postoperative cardiac arrhythmias, the predictive power of SBARV was stronger（SBARVOR=2.92, DBARVOR=1.941 ）. Conclusion SBARV and DBARv value can predict the occurrence of malignant arrhythmia after coronary artery bypass grafting. Attention should also be paid to the blood pressure variability after operation, the postoperative blood pressure to maintain stability.