Murthy Sudish C, Law Simon, Whooley Brian P, Alexandrou Andreas, Chu Kent-Man, Wong John
Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
J Thorac Cardiovasc Surg. 2003 Oct;126(4):1162-7. doi: 10.1016/s0022-5223(03)00974-7.
Postoperative atrial fibrillation complicates recovery in 20% to 25% of patients after esophagectomy for cancer. The purpose of this study is to understand this phenomenon.
Between 1982 and 2000, 198 (22% of 921) patients had postoperative atrial fibrillation after esophagectomy. Propensity scoring and the Greedy Match algorithm were used to develop a cohort of control patients for statistical comparisons. One hundred forty-four patients who had postoperative atrial fibrillation were matched.
Pulmonary complications affected 42% of patients in the atrial fibrillation group compared with 17% in the control group (P <.001). Anastomotic leakage was more common in the atrial fibrillation group (6.9% vs 1.4%, P =.035). Surgical sepsis migrated with atrial fibrillation 4 times more frequently (P =.001). Multivariate analysis demonstrated that postoperative pulmonary complications (odds ratio, 2.5; 95% confidence interval, 1.42-4.3) and surgical sepsis (odds ratio, 3.4; 95% confidence interval, 1.2-9.6) were associated with postoperative atrial fibrillation. The mortality rates of the atrial fibrillation and control groups were 23% and 6.3%, respectively (P <.001). Median survival, excluding hospital deaths, was not different at 14.5 months (atrial fibrillation group) and 16.9 months (control group; P =.4).
Atrial fibrillation is a surrogate for surgical morbidity and mortality after esophagectomy. The occurrence of atrial fibrillation after esophageal resection should prompt not only the appropriate management of the arrhythmia but also a search for a more ominous underlying cause.
在因癌症行食管切除术后的患者中，20%至25%会出现术后房颤，这使恢复过程变得复杂。本研究的目的是了解这一现象。
1982年至2000年间，198例（921例中的22%）患者在食管切除术后出现了术后房颤。采用倾向评分法和贪婪匹配算法来建立一组对照患者进行统计学比较。对144例出现术后房颤的患者进行了匹配。
房颤组42%的患者出现肺部并发症，而对照组为17%（P<.001）。房颤组吻合口漏更为常见（6.9%对1.4%，P=.035）。手术部位感染与房颤同时出现的频率高出4倍（P=.001）。多因素分析表明，术后肺部并发症（比值比，2.5；95%置信区间，1.42 - 4.3）和手术部位感染（比值比，3.4；95%置信区间，1.2 - 9.6）与术后房颤相关。房颤组和对照组的死亡率分别为23%和6.3%（P<.001）。排除医院死亡病例后，房颤组的中位生存期为14.5个月，对照组为16.9个月，两者无差异（P=.4）。
房颤是食管切除术后手术并发症和死亡率的一个替代指标。食管切除术后房颤的发生不仅应促使对心律失常进行适当处理，还应寻找更不祥的潜在病因。
