老年冠心病患者体外循环冠脉旁路移植术后新发房颤的危险因素分析

Risk factors analysis of eldery coronary heart disease patients new atrial fibrillation after on-pump coronary artery bypass grafting operation

目的 探究老年冠心病患者体外循环冠脉旁路移植(ONCAB)术后新发房颤的危险因素。方法 选择郑州大学第一附属医院2018年3月—2020年5月收治行ONCAB的老年冠心病患者260例,收集患者一般资料、临床资料及术后12 h心电图,并通过单因素分析、多因素Logistic回归分析筛选老年冠心病患者ONCAB后新发房颤的危险因素。结果 单因素分析显示,年龄、合并糖尿病、COPD病史、术前左心房内径、机械通气时间、输注悬浮红细胞(RBC)量是老年冠心病患者ONCAB后新发房颤的危险因素(P<0.05);多因素Logistic回归分析显示,年龄>70岁、合并糖尿病、术前左心房内径≥38 mm、机械通气时间≥3 d、输注悬浮红细胞(RBC)量高是老年冠心病患者ONCAB后新发房颤的独立危险因素(P<0.05)。结论 老年冠心病患者ONCAB后新发房颤多发生于术后5 d,且术后第2天为高峰期,临床加强对年龄>70岁、合并糖尿病、术前左心房内径≥38 mm、机械通气时间≥3 d、输注悬浮红细胞(RBC)量升高患者的关注,强化风险防控及临床护理干预。

Objective To investigate the risk factors analysis of eldery coronary heart disease patients new atrial fibrillation after on-pump coronaly artery bypass grafting(ONCAB) operation. Methods A total of 260 elderly patients with coronary heart disease who received ONCAB from March 2018 to May 2020 in the First Affiliated Hospital of Zhengzhou University were selected. The general data, clinical data and 12 h electrocardiogram after operation were collected. The risk factors of new atrial fibrillation after ONCAB in elderly patients with coronary heart disease were screened by univariate analysis and multivariate Logistic regression analysis. Results Univariate analysis showed that, age, diabetes mellitus, disease history of COPD, preoperative left atrial diameter, mechanical ventilation time, volume of suspended red blood cells(RBC) were the risk factors of new atrial fibrillation after ONCAB in elderly patients with coronary heart disease(CHD)(P<0.05). Multivariate Logistic regression analysis showed that, age >70 years old, diabetes mellitus, preoperative left atrial diameter ≥38 mm, mechanical ventilation time ≥3 d and high volume of suspended red blood cells(RBC) were independent risk factors of new atrial fibrillation after ONCAB in elderly patients with coronary heart disease(P<0.05). Conclusion New atrial fibrillation in elderly patients with coronary heart disease after ONCAB was more frequent at 5 d after surgery, and the peak is on the second day after surgery >70 years old, clinical should paid more attention on complicated with diabetes mellitus, preoperative left atrial inner diameter ≥38 mm, mechanical ventilation time clinical should paid more attention on≥ 3 d, infusion suspended red blood cells(RBC) volume increased strengthen risk prevention control and clinical nursing intervention.