Fleming Gregory A, Murray Katherine T, Yu Chang, Byrne John G, Greelish James P, Petracek Michael R, Hoff Steven J, Ball Stephen K, Brown Nancy J, Pretorius Mias
Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Circulation. 2008 Oct 14;118(16):1619-25. doi: 10.1161/CIRCULATIONAHA.108.790162. Epub 2008 Sep 29.
Postoperative atrial fibrillation (AF), a frequent complication after cardiac surgery, causes morbidity and prolongs hospitalization. Inotropic drugs are commonly used perioperatively to support ventricular function. This study tested the hypothesis that the use of inotropic drugs is associated with postoperative AF.
We evaluated perioperative risk factors in 232 patients who underwent elective cardiac surgery. All patients were in sinus rhythm at surgery. Sixty-seven patients (28.9%) developed AF a mean of 2.9+/-2.1 days after surgery. Patients who developed AF stayed in the hospital longer (P<0.001) and were more likely to die (P=0.02). Milrinone use was associated with an increased risk of postoperative AF (58.2% versus 26.1% in nonusers; P<0.001). Older age (63.4+/-10.7 versus 56.7+/-12.3 years; P<0.001), hypertension (P=0.04), lower preoperative ejection fraction (P=0.03), mitral valve surgery (P=0.02), right ventricular dysfunction (P=0.03), and higher mean pulmonary artery pressure (27.1+/-9.3 versus 21.8+/-7.5 mm Hg; P=0.001) also were associated with postoperative AF. In multivariable logistic regression, age (P<0.001), ejection fraction (P=0.02), and milrinone use (odds ratio, 4.86; 95% confidence interval, 2.31 to 10.25; P<0.001) independently predicted postoperative AF. When only data from patients with pulmonary artery catheters were analyzed and pulmonary artery pressure was included in the model, age, milrinone use (odds ratio, 4.45; 95% confidence interval, 2.01 to 9.84; P<0.001), and higher pulmonary artery pressure (P=0.02) were associated with an increased risk of postoperative AF. Adding other potential confounders or stratifying analysis by mitral valve surgery did not change the association of milrinone use with postoperative AF.
Milrinone use is an independent risk factor for postoperative AF after elective cardiac surgery.
术后心房颤动（AF）是心脏手术后常见的并发症，会导致发病并延长住院时间。围手术期常用强心药物来支持心室功能。本研究检验了强心药物的使用与术后AF相关的假设。
我们评估了232例行择期心脏手术患者的围手术期危险因素。所有患者手术时均为窦性心律。67例患者（28.9%）术后平均2.9±2.1天发生AF。发生AF的患者住院时间更长（P<0.001），死亡可能性更大（P=0.02）。使用米力农与术后AF风险增加相关（使用者为58.2%，未使用者为26.1%；P<0.001）。年龄较大（63.4±10.7岁对56.7±12.3岁；P<0.001）、高血压（P=0.04）、术前射血分数较低（P=0.03）、二尖瓣手术（P=0.02）、右心室功能障碍（P=0.03）以及平均肺动脉压较高（27.1±9.3对21.8±7.5 mmHg；P=0.001）也与术后AF相关。在多变量逻辑回归分析中，年龄（P<0.001）、射血分数（P=0.02）和米力农的使用（比值比，4.86；95%置信区间，2.31至10.25；P<0.001）可独立预测术后AF。当仅分析有肺动脉导管患者的数据并将肺动脉压纳入模型时，年龄、米力农的使用（比值比，4.45；95%置信区间，2.01至9.84；P<0.001）以及较高的肺动脉压（P=0.02）与术后AF风险增加相关。添加其他潜在混杂因素或按二尖瓣手术进行分层分析并未改变米力农使用与术后AF的关联。
使用米力农是择期心脏手术后发生术后AF的独立危险因素。
