Auer J, Weber T, Berent R, Ng C K, Lamm G, Eber B
Department of Cardiology and Intensive Care, General Hospital Wels, Wels, Austria.
J Cardiovasc Surg (Torino). 2005 Dec;46(6):583-8.
Postoperative atrial fibrillation (AF) occurs in up to 50% of cardiac surgery patients and represents the most common postoperative arrhythmic complication. A reduction of the length of hospital stay is a desirable goal in preventive strategies of postoperative AF. The aim of the present investigation was to determine whether prolonged postoperative hospital stay associated with AF after cardiac surgery surgery is attributable to the arrhythmia itself or to baseline characteristics of patients who develop AF.
Patients undergoing elective cardiac surgery in the absence of heart failure and significant left ventricular dysfunction (n = 253; average age 65+/-11 years) were recruited to the present prospective study. Midline sternotomy procedures with standard surgical techniques for normothermic cardiopulmonary bypass in coronary artery bypass grafting and valvular surgery were used.
A total of 99 patients (39.1%) of the study population developed AF during the postoperative period. AF patients were older and more likely to have surgery for valvular heart disease and less likely to have antiarrhythmic drugs including beta-adrenergic blockers than patients without AF, but both patients with and without AF had similar body mass index and duration of surgery. Postoperative hospital stays were longer in patients with AF compared to those without AF (14.9+/-5.7 vs 10.6+/-3.6, respectively; P = 0.001). Multivariate analysis, adjusted for age and postoperative complications, demonstrated that postoperative hospital stay was 14.2+/-5.3 days in patients with AF and 10.8+/-3.8 days in patients without AF (P < 0.01). Treatment with oral antiarrhythmic drugs that reduce AF is associated with a reduction of postoperative hospital stay.
Despite baseline characteristics differed between patients with and without postoperative AF, most of the prolongation of hospital stay can be attributed to the rhythm disturbance itself.
心脏手术患者术后房颤（AF）发生率高达50%，是最常见的术后心律失常并发症。缩短住院时间是术后房颤预防策略中一个理想的目标。本研究的目的是确定心脏手术后与房颤相关的术后住院时间延长是归因于心律失常本身还是发生房颤患者的基线特征。
本前瞻性研究纳入了在无心力衰竭和严重左心室功能不全情况下接受择期心脏手术的患者（n = 253；平均年龄65±11岁）。采用正中胸骨切开术及冠状动脉搭桥术和瓣膜手术中常温体外循环的标准手术技术。
研究人群中共有99例患者（39.1%）在术后发生房颤。与未发生房颤的患者相比，房颤患者年龄更大，更有可能接受瓣膜性心脏病手术，使用包括β受体阻滞剂在内的抗心律失常药物的可能性更小，但发生房颤和未发生房颤的患者体重指数和手术时间相似。房颤患者的术后住院时间比未发生房颤的患者更长（分别为14.9±5.7天和10.6±3.6天；P = 0.001）。在对年龄和术后并发症进行校正的多变量分析中，房颤患者的术后住院时间为14.2±5.3天，未发生房颤的患者为10.8±3.8天（P < 0.01）。使用可减少房颤的口服抗心律失常药物治疗与术后住院时间缩短相关。
尽管术后发生房颤和未发生房颤的患者基线特征不同，但住院时间的延长大多可归因于心律失常本身。
