非体外循环下冠状动脉旁路移植术后新发心房颤动的危险因素分析

Risk factors of new-onset postoperative atrial fibrillation after off-pump coronary artery bypass grafting

目的探讨非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCAB后新发心房颤动(new-onset postoperative atrial fibrillation,POAF)的危险因素。方法回顾性分析泰达国际心血管病医院心脏外科2016年1月至2018年1月行单纯OPCAB 583例患者的临床资料,其中男434例、女149例,平均年龄(62.79±8.08)岁。根据患者是否发生POAF而分为POAF组(158例)和非POAF组(425例)。对两组患者围术期的临床参数分别进行单因素分析。而后,将单因素分析中具有统计学意义的因素纳入多因素logistic回归分析,以确定其是否为POAF的独立危险因素。结果单因素分析结果显示,年龄≥65岁(P=0.012)、既往慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病史(P=0.028)、左房内径(LAD)≥38mm(P=0.016)及中性粒细胞与淋巴细胞比值(NLR,P=0.002)与POAF相关。logistic多因素回归分析显示,年龄≥65岁(OR=1.717,P=0.006)、LAD≥38 mm(OR=1.562,P=0.023)及较高的NLR(OR=1.215,P=0.022)是POAF的独立危险因素,而既往有COPD病史(OR=2.489,P=0.326)无统计学意义。结论在OPCAB的患者中,高龄(年龄≥65岁)、LAD扩大(≥38 mm)及较高的NLR水平是POAF的独立危险因素。

Objective To investigate the risk factors of new-onset postoperative atrial fibrillation(POAF)in patients who underwent isolated off-pump coronary artery bypass grafting(OPCAB).Methods Between January 2016 and January 2018,a total of 583 patients who underwent OPCAB in TEDA International Cardiovascular Hospital were retrospectively analyzed.There were 434 males and 149 females with an average age of 62.79±8.08 years.The patients were divided into 2 groups,a POAF group(n=158)and a non-POAF group(n=425),in accordance with the occurrence of POAF.The perioperative clinical parameters of the two groups were analyzed by univariate analysis.Then,statistically significant factors in the univariate analysis were subjected to multivariate logistic regression analysis to determine if it was an independent risk factor for POAF.Results Univariate analysis showed that age≥65 years(P=0.012),history of chronic obstructive pulmonary disease(COPD,P=0.028),left atrial diameter(LAD)≥38 mm(P=0.016)and neutrophillymphocyte ratio(NLR,P=0.002)were related to POAF.Logistic multivariate regression analysis showed that age≥65 years(OR=1.717,P=0.006),LAD≥38 mm(OR=1.562,P=0.023)and higher NLR level(OR=1.215,P=0.022)were the independent risk factors of POAF after OPCAB,but not previous history of COPD(OR=2.489,P=0.326).Conclusion In patients with OPCAB,advanced age(≥65 years),LAD enlargement(≥38 mm)and higher NLR level are the independent risk factors of POAF after OPCAB.