单纯主动脉瓣置换术后心房颤动的危险因素分析

Risk factors of atrial fibrillation following isolated aortic valve replacement

目的:探讨单纯主动脉瓣置换术后心房颤动(房颤)的发生率及相关危险因素。方法:回顾性收集2010年1月至2013年3月在长海医院行单纯主动脉瓣置换术,且术前基础心律为窦性的180例患者的临床资料,计算术后房颤的总体发生率。根据术后是否发生房颤将患者分为房颤组和非房颤组,通过单因素及多因素分析,明确术后房颤发生的独立危险因素。结果:39例患者术后发生房颤,发生率为21.67%。单因素分析显示,房颤组年龄、左房容积、左室质量、主动脉阻断时间均显著大于非房颤组(P均<0.05)。多因素logistic回归分析显示,年龄>60岁(P=0.008,OR=3.093)、左房容积>75 m L(P=0.018,OR=2.608)及主动脉阻断时间>70 min(P=0.042,OR=3.003)是影响术后房颤发生的独立危险因素。结论:单纯主动脉瓣置换术后房颤并不少见,高龄、左房容积较大及主动脉阻断时间较长的患者术后发生心房颤动的风险更高。

Objective:To investigate the incidence and risk factors of atrial fibrillation(AF)following isolated aortic valve replacement(AVR).Methods:Clinical materials of 180 patients with sinus rhythm preoperatively undergoing isolated AVR in our department fromjanuary 2010 to March 2013 were reviewed.The overall incidence of postoperative AF was calculated.On the basis of whether AF occurred postoperatively,this cohort of patients was divided into the AF group and non-AF group.Independent risk factors of the occurrence of postoperative AF were evaluated via univariate and multivariate analysis.Results:The incidence of postoperative AF in this cohort was 21.67%(39 cases).Univariate analysis demonstrated that the average age,left atrial volume,left ventricular mass and aortic cross-clamp time were significantly higher in AF group,as compared with non-AF group(P<0.05).Multivariate logistic regression analysis revealed that age>60 years old(P=0.008,OR=3.093),left atrial volume>75 mL(P=0.018,OR=2.608),and aortic cross-clamp time>70 min(P=0.042,OR=3.003)were independent risk factors of AF following isolated AVR.Conclusions:AF is not uncommon after isolated AVR and the risk of AF following isolated AVR is higher in patients with advanced age,larger left atrial volume and longer aortic cross-clamp time.