非体外循环下冠状动脉旁路移植术术后心脏自主神经功能变化与术后心房颤动的关系

Relationship between cardiac autonomic function and postoperative atrial fibrillation after off-pump coronary artery bypass grafting

目的探讨在非体外循环下冠状动脉旁路移植术(OPCABG)术后心脏自主神经功能变化与术后心房颤动的关系。方法本研究为回顾性研究, 选取2021年2月—11月北部战区总医院心血管外科行冠状动脉旁路移植术(CABG)的516例患者, 收集患者临床基础资料和围术期动态心电图全部窦性心博RR间期的标准差(SDNN)指标资料。男380例, 女136例, 年龄(62.97±8.36)岁, 年龄范围为35~80岁, 根据OPCABG术后患者是否发生心房颤动将其分为心房颤动组(n=140)与非心房颤动组(n=376)。根据心率变异性SDNN下降的严重程度, 分析自主神经功能下降程度和术后心房颤动的发生关系。结果两组患者体质量指数、左室射血分数(LVEF)值、Killip分级、心功能美国纽约心脏病协会(NYHA)分级、心肌梗死次数比较, 差异均无统计学意义(P>0.05)。术前129例患者SDNN>100 ms, 95%CI:60.43~103.49;术后5例患者SDNN>100 ms, 95%CI:43.68~72.34, 两者比较差异有统计学意义(P<0.001)。术后共511例患者SDNN低于正常值, 根据术后是否发生心房颤动将其分为术后心房颤动组(n=137)及窦性心律组(n=374)。术后心房颤动组术后SDNN值[(60.71±13.48)ms]与窦性心律组术后SDNN值[(56.33±13.22)ms]比较, 差异有统计学意义(P<0.001)。根据SDNN的范围, 分为SDNN中度下降组(50~100 ms)与SDNN重度下降组(<50 ms)。中度下降组心房颤动发生率[29.5%(105/356)]高于重度下降组心房颤动发生率[20.6%(32/155)], 差异有统计学意义(P=0.039)。结论 OPCABG术后患者早期自主神经功能下降, 自主神经功能下降和房颤发生的关系是非线性的, SDNN中度下降时下术后心房颤动更容易发生。

Objective To investigate the relationship between the changes of cardiac autonomic nervous function and atrial fibrillation after off-pump coronary artery bypass grafting(OPCABG).Methods This study was a retrospective study,a total of 516 patients who underwent coronary artery bypass grafting(CABG)in the department of Cardiovascular Surgery in the General Hospital of Northern Theater Command from February 2021 to November 2021 were selected to collect basic clinical data and standard deviation of beat to beat intervals(SDNN)of all sinus ecg during perioperative period.There were 380 males and 136 females,aged(62.97±8.36)years old,ranging from 35 to 80 years old.The patients were divided into atrial fibrillation group(n=140)and non-atrial fibrillation group(n=376)according to the occurrence of atrial fibrillation after OPCABG.According to the severity of heart rate variability SDNN decline,the relationship between autonomic nervous function decline and postoperative atrial fibrillation was analyzed.Results There were no significant differences in body mass index,left ventricular ejection fraction(LVEF),Killip class,New York Heart Association(NYHA)class and the number of myocardial infarction between the two groups(P>0.05).There were 129 cases with preoperative SDNN>100 ms,95%CI:60.43 to 103.49,there were 5 cases with SDNN>100 ms after operation,95%CI:43.68 to 72.34,and the difference was statistically significant(P<0.001).SDNN was lower than normal in 511 patients after operation,they were divided into postoperative atrial fibrillation group(n=137)and sinus rhythm group(n=374)according to whether atrial fibrillation occurred or not.The postoperative SDNN between postoperative atrial fibrillation group[(60.71±13.48)ms]and sinus rhythm group[(56.33±13.22)ms],the difference was statistically significant(P<0.001).According to the range of SDNN,the patients were divided into moderate decrease SDNN group(50 to 100 ms)and severe decrease SDNN group(<50 ms).The incidence of atrial fibrillation in moderate decline group[29.5%(105/356)]was higher than that in severe decline group[20.6%(32/155)],and the difference was statistically significant(P=0.039).Conclusions The relationship between decreased autonomic nerve function and atrial fibrillation was nonlinear in the early stage after OPCABG,and atrial fibrillation was more likely to occur when SDNN was moderately decreased.