机器人心脏外科术后心律失常危险因素的回顾性队列研究

Risk factors for arrhythmia after robotic cardiac surgery:A retrospective cohort study

目的探讨机器人心脏外科术后心律失常的危险因素。方法回顾性分析2016年7月—2022年6月于陆军军医大学大坪医院行机器人体外循环下心脏外科手术患者的临床资料。按患者术后是否发生心律失常分为心律失常组和非心律失常组。采用单因素分析和多因素logistic分析筛选机器人心脏外科术后心律失常的危险因素。结果共纳入146例患者,其中男55例、女91例,平均年龄(43.03±13.11)岁。心律失常组23例,非心律失常组123例。院内死亡1例(0.49%)。单因素分析提示年龄、体重、体重指数、糖尿病、心功能(NYHA)分级、左房前后径、左室前后径、右室前后径、总胆红素、直接胆红素、尿酸、红细胞宽度、手术时间、体外循环时间、主动脉阻断时间、手术类型与术后发生心律失常有关(P<0.05)。多因素二元logistic回归分析提示,直接胆红素水平[OR=1.334,95%CI(1.003,1.774),P=0.048]、主动脉阻断时间[OR=1.018,95%CI(1.005,1.031),P=0.008]是机器人心脏外科术后心律失常的独立危险因素。心律失常组术后气管带管时间(P<0.001)、监护室停留时间(P<0.001)、术后住院时间(P<0.001)明显延长,术后大剂量输血事件明显增加(P=0.002)。结论术前直接胆红素水平、主动脉阻断时间是机器人心脏外科术后心律失常的独立危险因素;术后心律失常患者术后气管带管时间、监护室停留时间、术后住院时间明显延长,术后大剂量输血事件显著增加。

Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery.Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass(CPB)from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed.According to whether arrhythmia occurred after operation,the patients were divided into an arrhythmia group and a non-arrhythmia group.Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery.Results A total of 146 patients were enrolled,including 55 males and 91 females,with an average age of 43.03±13.11 years.There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group.One(0.49%)patient died in the hospital.Univariate analysis suggested that age,body weight,body mass index(BMI),diabetes,New York Heart Association(NYHA)classification,left atrial anteroposterior diameter,left ventricular anteroposterior diameter,right ventricular anteroposterior diameter,total bilirubin,direct bilirubin,uric acid,red blood cell width,operation time,CPB time,aortic cross-clamping time,and operation type were associated with postoperative arrhythmia(P<0.05).Multivariate binary logistic regression analysis suggested that direct bilirubin(OR=1.334,95%CI 1.003-1.774,P=0.048)and aortic cross-clamping time(OR=1.018,95%CI 1.005-1.031,P=0.008)were independent risk factors for arrhythmia after robotic cardiac surgery.In the arrhythmia group,postoperative tracheal intubation time(P<0.001),intensive care unit stay(P<0.001)and postoperative hospital stay(P<0.001)were significantly prolonged,and postoperative high-dose blood transfusion events were significantly increased(P=0.002).Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiacsurgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantlyprolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events aresignificantly increased.