不停跳冠状动脉移植术后心房颤动危险因素分析

Analysis of clinical risk factor of atrial fibrillation after off-pump coronary artery bypass

目的:分析不停跳冠状动脉移植术(OPCABG)后,心房颤动发生的临床相关因素,为临床预防和治疗术后发生的心房颤动(AF)提供参考依据。方法:收集大兴区人民医院2013年1月至2016年12月期间,128例OPCABG患者,观察围术期的相关临床资料,按术后是否发生AF,分为AF组42例和非AF组86例。对比两组患者的临床资料,分析患者年龄、左心房内径(LAD)、左心室射血分数(LVEF)、术前动脉氧分压、右冠状动脉主干狭窄(≥70%)等因素与OPCABG术后AF发生的相关性。结果:OPCABG术后AF发生率为32.8%,多发生于术后1~3d。两组间比较显示:AF组年龄、左心室射血分数、左心房内径、动脉氧分压、右冠状动脉主干狭窄(≥70%)与非AF组比较,差异有统计学意义(P<0.05)。多因素Logistic分析结果提示:年龄、左心房内径、右冠状动脉主干狭窄(≥70%)是OPCABG术后发生AF的危险因素。结论:OPCABG术后AF的发生与年龄、左心房内径、右冠状动脉主干狭窄(≥70%)密切相关。

Objective： To analyze the relative risk factors of atrial fibrillation in patients after off-pump coronary artery bypass grafting(OPCABG）. The study should be used to guide the clinical prevention and treatment of postoperative atrial fibrillation. Methods： The clinical data of 128 cases of OPCABG from January 2013 to December 2016 were collected. All the patients were divided into 42 cases of AF group and 86 cases of nonAF group according to the postoperative occurrence of AF. By compared the clinical relative factors of the two groups patients,analyzed the factors of age,left atrial diameter,left ventricular ejection fraction,preoperative arterial oxygen partial pressure,right coronary artery stenosis with AF after OPCABG. Results： Postoperative AF occurred in 42 casesafter off-pump coronary artery bypass grafting mostly occurred on d1-d3 after surgery. Univariate analysis showed that the age,left atrial diameter,and the right coronary artery stenosis(≥70%） in the AF group were significantly higher than that of the non-AF group,left ventricular ejection fraction,the arterial oxygen partial pressure in the AF group were significantly lower than that of the non-AF group,and the differences were statistically significant(P〈0. 05）. Multiple Logistic regression analysis showed that the age,LAD and right coronary artery stenosis(≥70%） were the independent risk factors for the occurrence of AF after OPCABG. Conclusion： The occurrence of AF after OPCABG is closely related to the age,LAD and the right coronary artery stenosis(≥70 %）.