体外循环下冠状动脉旁路移植术后新发房颤的危险因素分析

Risk factors of new-onset post-operative atrial fibrillation after on-pump coronary artery bypass graft surgery

目的 探讨体外循环下冠状动脉旁路移植（on-pump coronary artery bypass grafting,ONCAB）术后新发房颤的危险因素,为ONCAB术后新发房颤的预防和治疗提供参考.方法 收集我院心脏外科2015年1月至2016年5月间357例单纯ONCAB患者的临床资料,根据术后是否发生新发房颤而分为房颤组和非房颤组.对两组患者围术期的临床参数进行统计分析,从而筛选术后新发房颤的独立危险因素.结果 ONCAB术后新发房颤的发生率为23.8％（85例）.单因素分析结果显示,年龄≥65岁（P=0.02）、慢性阻塞性肺疾病病史（P=0.03）及术前左心房内径≥38 mm（P＜0.001）与ONCAB术后新发房颤相关.多因素Logistic回归分析显示,年龄≥65岁（OR=1.720,P=0.039）、慢性阻塞性肺疾病病史（OR=11.924,P=0.032）及左心房内径≥38 mm（OR=2.735,P＜0.001）是ONCAB术后患者发生新发房颤的独立危险因素.结论 高龄（≥65岁）、慢性阻塞性肺疾病病史及左心房内径增大（≥38 mm）与ONCAB术后新发房颤相关,是潜在的预测因子.

Objective This study aims to determine the risk factors of new-onset post-operative atrial fibrillation （POAF） in patients who underwent isolated on-pump coronary artery bypass grafting （ONCAB） so as to provide a basis for the prevention and treatment of POAF after ONCAB. Methods Between January 2015 and June 2016, a total of 357 patients who underwent ONCAB in our department were retrospectively analyzed. The patients were divided into 2 groups, the POAF group and the non-POAF group, according to the occurrence of POAF. A comparative analysis was performed on the clinical characteristics of the patients to determine the risk factors of POAF. Results The incidence of POAF after ONCAB was 23.8% （85 cases）. Univariate analysis showed that the proportion of patients with age≥65 years or older（P=0.02）, history of chronic obstructive pulmonary disease （COPD） （P=0.03） and left atrium diameter （LAD） ≥38 mm （P〈0.001） were increased in POAF group, compared with non POAF group. Logistic multivariate regression analyses showed age≥65 （OR=1.720, P=0.039）, history of COPD（OR=11.924, P=0.032） and LAD≥38 ram（OR=2.735, P〈0.001） were the independent risk factors of POAF after ONCAB. Conclusion Advanced age（ ≥65 years old）, history of COPD and LAD enlargement （ ≥38 mm） were related with POAF after ONCAB and may became the independent predictors of POAF.