中国心血管杂志
中國心血管雜誌
중국심혈관잡지
CHINESE JOURNAL OF CARDIOVASOLOGY
2015年
2期
136-140
,共5页
俞国军%严飞%朱涛%刘正%霍强
俞國軍%嚴飛%硃濤%劉正%霍彊
유국군%엄비%주도%류정%곽강
心房颤动%冠状动脉疾病%冠状动脉旁路移植术,非体外循环%老年人%危险因素
心房顫動%冠狀動脈疾病%冠狀動脈徬路移植術,非體外循環%老年人%危險因素
심방전동%관상동맥질병%관상동맥방로이식술,비체외순배%노년인%위험인소
Atrial fibrillation%Coronary artery disease%Coronary artery bypass,off-pump%Aged%Risk factors
目的：探讨老年冠心病患者非体外循环冠状动脉旁路移植术后新发心房颤动的危险因素。方法回顾性分析159例老年非体外循环冠状动脉旁路移植术后患者资料,根据术后是否新发心房颤动分为两组,分析冠状动脉病变情况、旁路移植血管支数、术后电解质变化、循环血容量变化、抗心律失常药物使用等因素与术后新发心房颤动的相关性。结果35例患者术后出现心房颤动,发生率22.01%(35/159)。在单因素分析中,心房颤动组患者与非心房颤动组患者比较,年龄[(66.9±5.0)岁比(64.9±3.7)岁,P =0.009]、术前射血分数(42.66%±7.51%比45.94%±8.46%,P =0.039)、术前血氧饱和度(SpO2,89.67%±6.14%比92.00%±5.34%,P =0.029)、旁路移植血管支数[(3.3 ± 1.4)支比(2.7 ± 1.2)支,P =0.017]、术前3 d 脑钠肽(BNP)水平[(850.88±711.55) pg/ ml 比( 523.20±682.57) pg/ ml, P =0.014]、术后3 dBNP 水平[(2276.45±1281.82)pg/ ml比(1444.47±1163.38)pg/ ml,P =0.000]、术后3 d 血钾[(3.59±0.24) mmol/ L 比(4.01±0.62)mmol/ L,P =0.000]、术后3 d 血钙[(2.31±0.21)mmol/ L 比(2.23±0.07)mmol/ L,P =0.000]、住院天数[(21.5 ± 5.4)d 比(19.4 ± 4.8)d,P =0.026]等指标差异均有统计学意义。 Logistic回归分析显示,年龄(OR：0.87,95% CI：0.776~0.976)、合并心脏瓣膜病(OR：0.149,95% CI：0.034~0.658)、术前 SpO2(OR：1.092,95% CI：1.012~1.117)、旁路移植血管支数(OR：0.543,95% CI：0.349~0.845)、术后3 dBNP 水平(OR：1.000,95% CI：0.999~1.000)、术后3 d 血钾(OR：3.842,95% CI：1.227~12.029)、术后3 d 血钙(OR：0.007,95% CI：0.000 ~0.520)与术后新发心房颤动具有显著相关性(均为 P <0.05)。结论年龄>65岁、合并心脏瓣膜病、术前 SpO2<90%、旁路移植血管支数>3支、围术期电解质紊乱是老年非体外循环冠状动脉旁路移植术后新发心房颤动的危险因素。
目的：探討老年冠心病患者非體外循環冠狀動脈徬路移植術後新髮心房顫動的危險因素。方法迴顧性分析159例老年非體外循環冠狀動脈徬路移植術後患者資料,根據術後是否新髮心房顫動分為兩組,分析冠狀動脈病變情況、徬路移植血管支數、術後電解質變化、循環血容量變化、抗心律失常藥物使用等因素與術後新髮心房顫動的相關性。結果35例患者術後齣現心房顫動,髮生率22.01%(35/159)。在單因素分析中,心房顫動組患者與非心房顫動組患者比較,年齡[(66.9±5.0)歲比(64.9±3.7)歲,P =0.009]、術前射血分數(42.66%±7.51%比45.94%±8.46%,P =0.039)、術前血氧飽和度(SpO2,89.67%±6.14%比92.00%±5.34%,P =0.029)、徬路移植血管支數[(3.3 ± 1.4)支比(2.7 ± 1.2)支,P =0.017]、術前3 d 腦鈉肽(BNP)水平[(850.88±711.55) pg/ ml 比( 523.20±682.57) pg/ ml, P =0.014]、術後3 dBNP 水平[(2276.45±1281.82)pg/ ml比(1444.47±1163.38)pg/ ml,P =0.000]、術後3 d 血鉀[(3.59±0.24) mmol/ L 比(4.01±0.62)mmol/ L,P =0.000]、術後3 d 血鈣[(2.31±0.21)mmol/ L 比(2.23±0.07)mmol/ L,P =0.000]、住院天數[(21.5 ± 5.4)d 比(19.4 ± 4.8)d,P =0.026]等指標差異均有統計學意義。 Logistic迴歸分析顯示,年齡(OR：0.87,95% CI：0.776~0.976)、閤併心髒瓣膜病(OR：0.149,95% CI：0.034~0.658)、術前 SpO2(OR：1.092,95% CI：1.012~1.117)、徬路移植血管支數(OR：0.543,95% CI：0.349~0.845)、術後3 dBNP 水平(OR：1.000,95% CI：0.999~1.000)、術後3 d 血鉀(OR：3.842,95% CI：1.227~12.029)、術後3 d 血鈣(OR：0.007,95% CI：0.000 ~0.520)與術後新髮心房顫動具有顯著相關性(均為 P <0.05)。結論年齡>65歲、閤併心髒瓣膜病、術前 SpO2<90%、徬路移植血管支數>3支、圍術期電解質紊亂是老年非體外循環冠狀動脈徬路移植術後新髮心房顫動的危險因素。
목적：탐토노년관심병환자비체외순배관상동맥방로이식술후신발심방전동적위험인소。방법회고성분석159례노년비체외순배관상동맥방로이식술후환자자료,근거술후시부신발심방전동분위량조,분석관상동맥병변정황、방로이식혈관지수、술후전해질변화、순배혈용량변화、항심률실상약물사용등인소여술후신발심방전동적상관성。결과35례환자술후출현심방전동,발생솔22.01%(35/159)。재단인소분석중,심방전동조환자여비심방전동조환자비교,년령[(66.9±5.0)세비(64.9±3.7)세,P =0.009]、술전사혈분수(42.66%±7.51%비45.94%±8.46%,P =0.039)、술전혈양포화도(SpO2,89.67%±6.14%비92.00%±5.34%,P =0.029)、방로이식혈관지수[(3.3 ± 1.4)지비(2.7 ± 1.2)지,P =0.017]、술전3 d 뇌납태(BNP)수평[(850.88±711.55) pg/ ml 비( 523.20±682.57) pg/ ml, P =0.014]、술후3 dBNP 수평[(2276.45±1281.82)pg/ ml비(1444.47±1163.38)pg/ ml,P =0.000]、술후3 d 혈갑[(3.59±0.24) mmol/ L 비(4.01±0.62)mmol/ L,P =0.000]、술후3 d 혈개[(2.31±0.21)mmol/ L 비(2.23±0.07)mmol/ L,P =0.000]、주원천수[(21.5 ± 5.4)d 비(19.4 ± 4.8)d,P =0.026]등지표차이균유통계학의의。 Logistic회귀분석현시,년령(OR：0.87,95% CI：0.776~0.976)、합병심장판막병(OR：0.149,95% CI：0.034~0.658)、술전 SpO2(OR：1.092,95% CI：1.012~1.117)、방로이식혈관지수(OR：0.543,95% CI：0.349~0.845)、술후3 dBNP 수평(OR：1.000,95% CI：0.999~1.000)、술후3 d 혈갑(OR：3.842,95% CI：1.227~12.029)、술후3 d 혈개(OR：0.007,95% CI：0.000 ~0.520)여술후신발심방전동구유현저상관성(균위 P <0.05)。결론년령>65세、합병심장판막병、술전 SpO2<90%、방로이식혈관지수>3지、위술기전해질문란시노년비체외순배관상동맥방로이식술후신발심방전동적위험인소。
Objective To examine the incidence and risk factors associated with new onset atrial fibrillation (AF) in the elderly coronary heart disease patients who underwent off-pump coronary artery bypass (OPCAB) surgery. Methods From April 2012 to April 2014, 159 elderly patients received OPCAB in our hospital. The patients were divided into AF group and non-AF group. Statistic analyses were used to screen risk factors of new onset AF after OPCAB. Results The incidence of AF after OPCAB is 22. 01%. Univariate analysis demonstrated that patients in AF group compared with those in non-AF group were more likely advanced age [(66. 9 ± 5. 0) years vs. (64. 9 ± 3. 7) years, P = 0. 009], preoperative SpO2 level (89. 67% ± 6. 14% vs. 92. 00% ± 5. 34% , P = 0. 029), preoperative EF (42. 66% ± 7. 51% vs. 45. 94%± 8. 46% , P = 0. 039), the numbers of vascular grafting [(3. 3 ± 1. 4)b vs. (2. 7 ± 1. 2)b, P = 0. 017], postoperative 3 days BNP level [(2 276. 45 ± 1 281. 82) pg/ ml vs. (1 444. 47 ± 1 163. 38) pg/ ml, P =0. 000], postoperative 3 days blood potassium level [(3. 59 ± 0. 24)mmol/ L vs. (4. 01 ± 0. 62)mmol/ L, P= 0. 000], postoperative 3 days serum calcium level [(2. 31 ± 0. 21)mmol/ L vs. (2. 23 ± 0. 07)mmol/ L, P = 0. 000], preoperative 3 days BNP level [(850. 88 ± 711. 55)pg/ ml vs. (523. 20 ± 682. 57)pg/ ml, P= 0. 014], hospitalization days [(21. 5 ± 5. 4) d vs. (19. 4 ± 4. 8) d, P = 0. 026]. Multivariate Logistic regression analyzes showed that age ( OR: 0. 87, 95% CI: 0. 776 - 0. 976), suffering from heart valve disease (OR: 0. 149, 95% CI: 0. 034 - 0. 658), preoperative SpO2 level (OR: 1. 092, 95% CI: 1. 012 -1. 117), the numbers of vascular grafting (OR: 0. 543, 95% CI: 0. 349 - 0. 845), postoperative 3 days BNP level (OR: 1. 000, 95% CI: 0. 999 - 1. 000), postoperative 3 days blood potassium level ( OR:3. 842, 95% CI: 1. 227 - 12. 029), postoperative 3 days serum calcium level (OR: 0. 007, 95% CI: 0. 000- 0. 520) were significantly related to AF. Conclusions Changes of perioperative electrolytes, decline in the oxygen saturation < 90% , suffering from the valvular heart disease, age > 65 years and the numbers of vascular grafting > 3 are risk factors of new onset AF in the elderly coronary heart disease patients who underwent OPCAB surgery.
