Salaria Vikrant, Mehta Nirav J, Abdul-Aziz Syed, Mohiuddin Syed M, Khan Ijaz A
Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska 21201, USA.
Clin Cardiol. 2005 Mar;28(3):131-5. doi: 10.1002/clc.4960280306.
Use of adrenergic (inotropic and vasopressor) drugs is common after cardiac surgery.
The study was undertaken to evaluate the role of postoperative adrenergic drug use as a predictor of postoperative atrial fibrillation (AF) after cardiac surgery.
The study population consisted of 199 patients post cardiac surgery. Postoperative adrenergic drug use and the baseline and clinical variables were analyzed as possible predictors of postoperative AF.
Of 199 patients, postoperative AF occurred in 59 patients (incidence 30%). The adrenergic drugs were used in 127 (64%) patients. Postoperative AF occurred in 49 of the 127 patients (39%) with and in 10 of the 72 patients (14%) without adrenergic drug use (p < 0.01). By univariate analyses, postoperative adrenergic drug use, age, left ventricular hypertrophy, left atrial size, valve surgery, aortic valve replacement, cross clamp time, bypass time, postoperative ventricular pacing, and hours in intensive care unit were predictors of development of postoperative AF. Atrial pacing was a predictor of freedom from developing AF. By multivariate logistic regression analysis, adrenergic drug use was an independent predictor of postoperative AF (odds ratio [OR] 3.35, 95% confidence interval [CI] 1.38-8.12, p = 0.016). Two other independent predictors were valve surgery (OR 2.88, 95% CI 1.31-6.35, p = 0.002) and age (OR 10.73, 95% CI 10.37-11.10, p = 0.0001). Adrenergic drug use, valve surgery, ventricular pacing, and age were predictors of time duration from surgery to the occurrence of AF. Drugs with predominantly beta1-adrenergic receptor affinity were associated with a higher incidence of postoperative AF (dopamine 44%, dobutamine 41% vs. phenylepherine 20%, p = 0.001).
Use of adrenergic drugs is an independent predictor of postoperative AF after cardiac surgery.
心脏手术后使用肾上腺素能（强心和血管加压）药物很常见。
本研究旨在评估心脏手术后使用肾上腺素能药物作为术后房颤（AF）预测指标的作用。
研究人群包括199例心脏手术后患者。分析术后肾上腺素能药物的使用情况以及基线和临床变量，将其作为术后房颤的可能预测指标。
199例患者中，59例发生术后房颤（发生率30%）。127例（64%）患者使用了肾上腺素能药物。127例使用肾上腺素能药物的患者中有49例（39%）发生术后房颤，72例未使用肾上腺素能药物的患者中有10例（14%）发生术后房颤（p<0.01）。单因素分析显示，术后使用肾上腺素能药物、年龄、左心室肥厚、左心房大小、瓣膜手术、主动脉瓣置换、阻断时间、体外循环时间、术后心室起搏以及重症监护病房停留时间是术后房颤发生的预测指标。心房起搏是未发生房颤的预测指标。多因素逻辑回归分析显示，使用肾上腺素能药物是术后房颤的独立预测指标（比值比[OR]3.35，95%置信区间[CI]1.38 - 8.12，p = 0.016）。另外两个独立预测指标是瓣膜手术（OR 2.88，95%CI 1.31 - 6.35，p = 0.002）和年龄（OR 10.73，95%CI 10.37 - 11.10，p = 0.0001）。使用肾上腺素能药物、瓣膜手术、心室起搏和年龄是从手术到房颤发生时间的预测指标。主要具有β1肾上腺素能受体亲和力的药物与术后房颤的较高发生率相关（多巴胺44%，多巴酚丁胺41% 对比 去氧肾上腺素20%，p = 0.001）。
使用肾上腺素能药物是心脏手术后术后房颤的独立预测指标。
