心脏外科术后发生室性心律失常的探讨

An investigation of ventricular arrhythmia after cardiac surgery operation

目的:探讨心脏外科患者术后室性心律失常(postoperative ventricular arrhythmias,POVA)的发生率、风险预测因子以及对远期生存率的影响。方法:回顾性连续选择自2018年1月至2021年12月,于首都医科大学附属北京安贞医院接受各类心脏外科手术的患者1226例,全因死亡率数据来自我院的数据库。构建Cox风险预测模型模型,以确定POVA发生的风险因素,并在调整不同的协变量后评价POVA对长期生存的独立影响。结果:在1226例患者,29例(2.4%)发生POVA。单变量分析显示:患者年龄较大(61.2±8.5)vs.(70.6±3.8)岁,较低的LVEF(61.1±9.2)%vs.(45.1±7.8)%,更多接受急诊心脏外科手术(1.6%vs.24.1%),有慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)病史(7.9%vs.24.1%),术前使用主动脉内球囊反搏(intra-aortic balloon pump,IABP,1.1%vs.6.9%),出现术后卒中病史(0.4%vs.3.5%),差异有统计学意义(P<0.05)。多变量Logistic回归分析则显示,年龄较大(OR:每1年增加1.08,P<0.001)、急诊手术(OR=19.38,95%CI:7.53~51.71,P<0.001)和存在严重COPD(OR=3.56,95%CI:1.54~8.86,P=0.002)与POVA发生呈现正向关联。在(2.0±0.1)年的随访中,POVA与显著增加的调整后长期死亡率(HR=7.95,95%CI:1.12~56.43,P=0.046)相关。结论:POVA与术后长期死亡率增加有关。年龄较大、严重的COPD、LVEF较低和急诊手术与POVA的风险较高相关。

Objective:To explore the incidence,risk predictors and impact on long-term survival of postoperative ventricular arrhythmias(POVA)in cardiac surgery patients.Methods:This retrospective study in chronological order,a total of 1226 patients who underwent various cardiac surgeries at Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2018 to December 2021 were continuously analyzed.All-cause mortality data came from our hospital’s electronic medical record database.A Cox risk prediction model was constructed to identify risk factors for the occurrence of POVA and evaluate the independent impact of POVA on long-term survival after adjusting for different covariates.Results:Among 1226 enrolled patients,29(2.4%)developed POVA.Univariate analysis showed that patients were older(61.2±8.5)vs(70.6±3.8),had lower left ventricular ejection fraction LVEF(61.1±9.2)%vs(45.1±7.8)%,and received more emergency cardiac surgery.Surgery(1.6%vs 24.1%),history of chronic obstructive pulmonary disease(COPD,7.9%vs 24.1%),preoperative use of intra-aorticballoon pump(IABP,1.1%vs.6.9%),and a history of postoperative stroke(0.4%vs.3.5%),which was statistically significant(P<0.05).Multivariable logistic regression analysis showed that older age(OR=1.08 increase per year,P<0.001),emergency surgery(OR=19.38,95%CI:7.53-51.71 P<0.001)and severe COPD(OR=3.56,95%CI:1.54-8.86,P=0.002)were associated a positive correlation with POVA occurrence.At(2.0±0.1)years of follow-up,POVA was associated with significantly increased adjusted long-term mortality(HR=7.95,95%CI:1.12-56.43,P=0.046).Conclusions:POVA is associated with increased long-term postoperative mortality.Older age,severe COPD,lower LVEF,and emergency surgery were associated with a higher risk of POVA.