Kuralay Erkan, Cingöz Faruk, Kiliç Selim, Bolcal Cengiz, Günay Celalettin, Demirkiliç Ufuk, Tatar Harun
GATA Cardiovascular Surgery Department, Gülhane Military Medical Academy, Yazanlar sokak No. 31/11, Asagi Ayranci, 06540, Ankara, Turkey.
Eur J Cardiothorac Surg. 2004 Feb;25(2):224-30. doi: 10.1016/j.ejcts.2003.11.006.
Supraventricular tachyarrhythmias (SVT) is common after coronary artery bypass grafting in chronic obstructive pulmonary disease (COPD). Preoperative FEV(1) is the major predetermining factor of mortality, morbidity and SVT.
Patients were divided into two groups according to their preoperative FEV(1) values. FEV(1) is <75% of predicted value in group 1 (no. 200), and >/=75% of predicted value in group 2 (no. 100). Group 1 is divided into two subgroups. SVT prophylaxis was not done in A subgroup (no. 100) whereas arrhythmia prophylaxis was done with amiodarone in all B subgroups (no. 100) in the early postoperative period.
Atrial fibrillation developed in 28 patients in group 1A, whereas it developed in 12 in group 1B (P=0.005). Atrial flutter developed in 10 patients in group 1A but in 3 patients in group 1B (P=0.045). Multifocal atrial tachycardia developed in 13 patients in group 1A and in 4 in group 1B (P=0.022). Multivariate analysis identified ejection fraction (P<0.002, odds ratio (OR) 0.93), inotropy requirement (P<0.001, OR 3.98) amiodarone (P<0.001, OR 0.18), and FEV(1)<75% of predicted value (P<0.048, OR 1.84) as predictor of SVT. There were statistically significant differences between A and B subgroups of group 1 for hospital (P<0.001) and intensive care unit (ICU) stay (P<0.001). There was also statistically significant difference between groups 1A and 2 comparison for ICU (P<0.001; 6.4+/-3.4 versus 1.4+/-0.6 days) and hospital stay (P<0.001; 17.6+/-8.2 versus 6.9+/-0.6 days).
Early prophylactic amiodarone not only significantly reduces SVT but also reduces SVT-related hospital and ICU stay. We strongly recommend prophylactic early use of amiodarone in COPD patients.
在慢性阻塞性肺疾病（COPD）患者冠状动脉搭桥术后，室上性快速心律失常（SVT）很常见。术前第一秒用力呼气容积（FEV₁）是死亡率、发病率和SVT的主要决定因素。
根据患者术前FEV₁值将其分为两组。第1组（200例）FEV₁<预测值的75%，第2组（100例）FEV₁≥预测值的75%。第1组再分为两个亚组。A亚组（100例）未进行SVT预防，而所有B亚组（100例）在术后早期用胺碘酮进行心律失常预防。
1A组有28例患者发生房颤，而1B组有12例（P=0.005）。1A组有10例患者发生房扑，而1B组有3例（P=0.045）。1A组有13例患者发生多源性房性心动过速，1B组有4例（P=0.022）。多因素分析确定射血分数（P<0.002，比值比（OR）0.93）、肌力需求（P<0.001，OR 3.98）、胺碘酮（P<0.001，OR 0.18）以及FEV₁<预测值的75%（P<0.048，OR 1.84）为SVT的预测因素。第1组A和B亚组在住院时间（P<0.001）和重症监护病房（ICU）停留时间（P<0.001）方面存在统计学显著差异。1A组和2组在ICU停留时间（P<0.001；6.4±3.4天对1.4±0.6天）和住院时间（P<0.001；17.6±8.2天对6.9±0.6天）比较上也存在统计学显著差异。
早期预防性使用胺碘酮不仅能显著降低SVT，还能缩短与SVT相关的住院时间和ICU停留时间。我们强烈建议在COPD患者中早期预防性使用胺碘酮。
