Hashimoto K, Ilstrup D M, Schaff H V
Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905.
J Thorac Cardiovasc Surg. 1991 Jan;101(1):56-65.
The influence of 45 variables on risk of postoperative supraventricular tachycardia was evaluated by univariate and multivariate analysis of data from 800 consecutive patients who underwent isolated coronary artery bypass during a 6-year interval. Postoperative supraventricular arrhythmias occurred in 186 patients (23%) but did not contribute to any of the six early deaths (30-day mortality rate, 0.8%). Mean (+/- standard deviation) length of hospital stay was longer (9.8 +/- 5.7 versus 8.3 +/- 3.5 days; p less than 0.0001) and mean age was older (65 versus 60 years; p less than 0.002) in patients with postoperative supraventricular tachycardia than in those with regular rhythm. Risk of supraventricular tachycardia was increased in patients with a history of atrial arrhythmias (45% versus 22%; p less than 0.002) or premature atrial contractions on the preoperative electrocardiogram (48% versus 22%; p less than 0.002). Multiple logistic regression analysis identified age 65 years or more, history of atrial arrhythmia or preoperative premature atrial contractions, and preoperative left ventricular end-diastolic pressure 20 mm Hg or more as independent predictors of postoperative supraventricular tachycardia. Six percent of patients converted to sinus rhythm spontaneously; 82% of patients converted within 1.1 +/- 1.9 days after onset of supraventricular tachycardia on treatment with digoxin or beta-adrenergic blocking drugs or both. Only 10% of patients with supraventricular tachycardia required electrical cardioversion. We conclude that the risk of supraventricular tachycardia after coronary artery bypass is influenced by patient-related variables and is effectively managed by conventional therapy. Prophylactic treatment should be reserved for elderly patients, especially those who have atrial arrhythmias or have preoperative left ventricular end-diastolic pressure 20 mm Hg or more.
通过对800例在6年期间连续接受单纯冠状动脉搭桥手术患者的数据进行单因素和多因素分析，评估了45个变量对术后室上性心动过速风险的影响。186例患者（23%）发生了术后室上性心律失常，但这6例早期死亡（30天死亡率为0.8%）均与之无关。术后发生室上性心动过速的患者，其平均（±标准差）住院时间更长（9.8±5.7天对8.3±3.5天；p<0.0001），平均年龄更大（65岁对60岁；p<0.002），而心律正常的患者则不然。有房性心律失常病史的患者（45%对22%；p<0.002）或术前心电图显示有房性早搏的患者（48%对22%；p<0.002），室上性心动过速的风险增加。多因素逻辑回归分析确定，年龄65岁及以上、有房性心律失常病史或术前房性早搏、术前左心室舒张末期压力20mmHg及以上是术后室上性心动过速的独立预测因素。6%的患者自发转为窦性心律；82%的患者在使用地高辛或β-肾上腺素能阻滞剂或两者治疗室上性心动过速发作后1.1±1.9天内转为窦性心律。只有10%的室上性心动过速患者需要电复律。我们得出结论，冠状动脉搭桥术后室上性心动过速的风险受患者相关变量影响，可通过传统治疗有效控制。预防性治疗应仅限于老年患者，尤其是那些有房性心律失常或术前左心室舒张末期压力20mmHg及以上的患者。
