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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

27卷

期数:

2021年06期

页码:

557-560

栏目:

心血管疾病专题

出版日期:

2021-11-15

文章信息/Info

Title:

Influencing factors of new-onset atrial fibrillation after off-pump coronary artery bypass grafting surgery

文章编号:

1006-8147（2021）06-0557-04

作者:

杨舒¹; 2; 胡奕瑾²; 朱希霞²; 王洪武²; 董素素²; 马骏¹

（1.天津医科大学公共卫生学院流行病与卫生统计学系，天津300070；2.泰达国际心血管病医院麻醉科，天津300457）

Author(s):

YANG Shu¹; 2; HU Yi-jin²; ZHU Xi-xia²; WANG Hong-wu²; DONG Su-su²; MA Jun¹

（1.Department of Epidemiology and Health Statistics，School of Public Health，Tianjin Medical University，Tianjin 300070，China；2.Department of Anesthesiology，TEDA International Cardiovascular Hospital，Tianjin 300457，China ）

关键词:

房颤; 非体外循环冠状动脉搭桥; 冠状动脉狭窄

Keywords:

atrial fibrillation;  off-pump coronary artery bypass grafting;  stenosis of coronary artery

分类号:

R541.4+R541.7+5

DOI:

-

文献标志码:

A

摘要:

目的：分析非体外循环冠状动脉搭桥(OPCABG)术后新发房颤的影响因素。方法：选取2019年1月—2019年8月择期行OPCABG术患者209例,术后住院期间确诊新发房颤患者36例（新发房颤组），未新发房颤患者173例（非房颤组）。比较两组患者的临床资料,进一步采用Logistic回归分析OPCABG术后新发房颤的影响因素。结果：新发房颤组右冠状动脉近段狭窄≥75%的比例、主动脉内球囊反搏（IABP）辅助率明显高于非房颤组（均P<0.05）；两组间其他临床资料差异均没有统计学意义（均P>0.05）；采用Logistic回归分析：右冠状动脉近段狭窄≥75%（OR=3.999，95%CI：2.072～19.753，P<0.00１），IABP辅助率（OR=6.397，95%CI：2.072～19.753，P<0.001）是OPCABG术后新发房颤的影响因素。结论：右冠状动脉近段狭窄≥75%，围术期需要IABP辅助是OPCABG患者术后新发房颤的影响因素。

Abstract:

Objective: To analyze the influencing factors of new-onset atrial fibrillation after off-pump coronary artery bypass grafting（OPCABG） suryery. Methods: A total of 209 patients who underwent elective OPCABG surgery from January 2019 to August 2019 were selected. During postoperative hospitalization，36 patients（new-onset atrial fibrillation group） were diagnosed with new-onset atrial fibrillation， and 173 patients（non-new atrial fibrillation group） were not. Clinical data of the two groups were collected and compared and the influencing factors of new-onset atrial fibrillation after OPCABG surgery were analyzed by Logistic regression. Results: The rate of proximal stenosis of right coronary artery（more than 75%） and intra-aortic balloon pump（IABP） supporting the new-onset atrial fibrillation group were significantly higher than those in the non-new atrial fibrillation group，and the difference was statistically significant（all P<0.05）. There was no statistically significant difference in other clinical data between the two groups（P>0.05）.Logistic regression analysis showed that proximal stenosis of right coronary artery（more than 75%）（OR=3.999，95%CI：2.072-19.753，P<0.001） and IABP auxiliary rate（OR=6.397，95%CI：2.072-19.753，P<0.001） were the influencing factors for the new occurrence of atrial fibrillation after OPCABG surgery. Conclusion: The proximal stenosis of right coronary artery（more than 75%） and the need for IABP support during perioperative period are the influencing factors for the patients with new-onset atrial fibrillation after off-pump coronary artery bypass grafting surgery.

参考文献/References:

[1] GIALDINI G，NEARING K，BHAVE P D，et al. Perioperative atrial fibrillation and the long-term risk of ischemic stroke[J]. JAMA，2014，312（6）：616
[2] BESSISSOW A，KHAN J，DEVEREAUX P J，et al. Postoperative atrial fibrillation in non-cardiac and cardiac surgery： an overview[J]. Thromb Haemost，2015，Suppl 1：S304
[3] DOBREV D，AGUILAR M，HEIJMAN J，et al. Postoperative atrial fibrillation： mechanisms，manifestations and management[J]. Nat Rev Cardiol，2019，16（7）：417
[4] DE LUNA A B，MART■NEZ-SELL?魪S M，BAY?魪S-GEN■S A，et al.Surface ECG interatrial block-guided treatment for stroke prevention：rationale for an attractive hypothesis[J]. BMC Cardiovasc Disord，2017，17（1）：211
[5] CHEBBOUT R，HEYWOOD E G，DRAKE T M，et al. A systematic review of the incidence of and risk factors for postoperative atrial fibrillation following general surgery[J]. Anaesthesia，2018，73（4）：490
[6] MAAROOS M，POHJANT M，N FOLLOWING HALONEN J，et al.New onset postoperative atrial fibrillation and early anticoagulation after cardiac surgery[J]. Scand Cardiovasc J，2017，51（6）：323
[7] LIN M H，KAMEL H，SINGER D E，et al. Perioperative/postoperative atrial fibrillation and risk of subsequent stroke and/or mortality[J]. Stroke，2019，50（6）：1364
[8] 黄从新，张澍，黄德嘉，等. 心房颤动：目前的认识和治疗的建议-2018[J]. 中国心脏起搏与心电生理杂志，2018，32（4）：315
[9] 中国高血压防治指南修订委员会，高血压联盟（中国，中华医学会心血管病学分会），中国医师协会高血压专业委员会，等. 中国高血压防治指南（2018年修订版）[J].中国心血管杂志，2019，24（1）：24
[10] 张雨薇，欧袁伟翔，熊真真，等. 2014年糖尿病重要临床指南和共识进展回顾[J]. 中国循证医学杂志，2015，15（8）：869
[11] GALDERISI M，COSYNS B，EDVARDSEN T，et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification，diastolic function，and heart valve disease recommendations： an expert consensus document of the European Association of Cardiovascular Imaging[J]. Eur Heart J Cardiovasc Imaging，2017，18（12）：1301
[12] BRAMER S，VAN STRATEN A H，SOLIMAN HAMAD M A，et al.The impact of new-onset postoperative atrial fibrillation on mortality after coronary artery bypass grafting[J]. Ann Thorac Surg，2010，90（2）：443
[13] MANGI A R，ZIA K，ALI T A，et al. Postoperative atrial fibrillation among patients undergoing isolated coronary artery bypass grafting[J].Cureus，2019，11（3）：e4333
[14] BUTT J H，XIAN Y，PETERSON E D，et al. Long-term thromboembolic risk in patients with postoperative atrial fibrillation after coronary artery bypass graft surgery and patients with nonvalvular atrial fibrillation[J]. JAMA Cardiol，2018，3（5）：417
[15] 蒙延海，刘平，王水云，等. 冠状动脉旁路移植术后新发心房颤动与术后早期和远期脑卒中及死亡相关性的Meta分析[J]. 中国循环杂志，2020，35（10）：977
[16] WALD R，DORIAN P，HAREL Z. Benefits and risks of anticoagulation iny bypass graft surgery and patients with nonvalvular atrial fibrillation[J]. Ann Thorac Surg，2010，75（3）：286
[17] PEHKONEN E，HONKONEN E，MONKONEN E，et al. Stenosis of the right coronary artery and retrograde cardioplegia predispose patients to atrial fibrillation after coronary artery bypass grafting[J].ThoracCardiovasc Surg，1998，46（3）：115
[18] 田本祥，张化一，姜相森，等. 国人窦房结动脉解剖特点的初步探讨—人窦房例CTA结果分析[J]. 医学影像学杂志，2012，22（10）：1661
[19] DEPPE A C，WEBER C，LIAKOPOULOS O J，et al. Preoperative intra-aortic balloon pump use in high-risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality-ameta-analysis of 9，212 patients[J]. J Card Surg，2017，32（3）：177
[20] ZHENG J B，HUA K，ZHANG K，et al. Prophylactic intra-aortic balloon pump in patients with left main disease undergoing off-pump coronary artery bypass grafting[J]. BMC Cardiovasc Disord，2020，20（1）：266
[21] MAYYAS F，ALZOUBI K H，VAN WAGONER D R. Impact of aldosterone antagonists on the substrate for atrial fibrillation： aldosterone promotes oxidative stress and atrial structural/electrical remodeling[J]. Int J Cardiol，2013，168（6）：5135
[22] TULLA H，HIPPELH M，TURPEINEN A，et al. New-onset atrial fibrillation at discharge in patients after coronary artery bypass surgery：short- and long-term morbidity and mortality[J]. Eur J Cardiothorac Surg，2015，48（5）：747
[23] SARTIPY U，DAHLSTR U，HOFU M，et al. Atrial fibrillation in heart failure with preserved，mid-range，and reduced ejection fraction[J]. JACC Heart Fail，2017，5（8）：565
[24] MARISCALCO G，BIANCARI F，ZANOBINI M，et al. Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery：the POAF score[J]. J Am Heart Assoc，2014，3（2）：e000752
[25] LEWICKI ?覥，SIEBERT J，ROGOWSKI J. Atrial fibrillation following off-pump versuson-pump coronary artery bypass grafting： incidence and risk factors[J]. CardiolJ，2016，23（5）：518

相似文献/References:

备注/Memo

备注/Memo:

基金项目 国家重点研发专项(2016YFC13022001) 作者简介 杨舒（1989-），女，硕士在读，研究方向:流行病与卫生统计学；通信作者:马骏，E-mail:majun@tmu.edu.cn。

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更新日期/Last Update: 2021-11-15