摘要
OBJECTIVE: To identify the clinical predictors of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). METHODS: 322 consecutive patients who had undergone isolated CABG were reviewed. Preoperative, intraoperative and postoperative data were collected. Patients were grouped according to whether AF appeared postoperatively. RESULTS: AF occurred in 75 patients (23.3%). Most cases of AF (85.6%) appeared on or before the third postoperative day. The mean age for patients with AF was 62.5 years compared with 56.7 years for patients without AF (P or = 65 years (OR 2.7; 95% CI 1.5 to 5.1), lesions in the right coronary artery (OR 2.5; 95% CI 1.4 to 4.5), and early postoperative withdrawal of beta blocker (OR 3.9; 95% CI 2.1 to 7.7). CONCLUSIONS: AF remains the most common complication after CABG. Age and lesions in the right coronary artery can influence the incidence of AF, and beta blocker and magnesium may be the most economical and effective prevention for AF early after CABG.
目的 房颤是冠状动脉旁路移植术后最常见的并发症。其病因目前尚不完全清楚 ,而且预防和治疗的方法亦非完全恰当。本回顾性研究的目的在于探讨房颤发生的相关因素。方法 回顾性地总结了连续 32 2例单纯CABG病例。收集术前、术中、术后临床资料 ,并依患者术后是否发生房颤分组 ,进行统计分析。结果 CABG术后 75例患者 (2 3 3%)发生了房颤 ,大部分 (85 6 %)发生于术后第 3天以内。发生房颤患者的平均年龄为 6 2 5岁 ,而无房颤者的平均年龄为 5 6 7岁 (P <0 0 5 )。房颤患者的主动脉阻断时间为 6 7分钟 ,无房颤者为 6 0 3分钟 (P <0 0 5 )。房颤患者的体外循环时间为 10 9 6分钟 ,而无房颤者仅 97 3分钟 (P <0 0 5 )。房颤患者的机械通气时间为 19 1小时 ,无房颤者为 15 7小时 (P <0 0 5 )。多因素回归分析的结果显示年龄大于 6 5岁、右冠近—中段大于 5 0 %狭窄、术后早期未服用β阻滞剂为独立危险因素。结论 房颤是CABG术后最常见的并发症。除年龄和RCA病变可以影响房颤的发生外 ,β阻滞剂和镁可能是预防术后早期房颤发生最经济、有效的方法。
