Department of Anesthesiology and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA.
Anesth Analg. 2010 Feb 1;110(2):329-34. doi: 10.1213/ANE.0b013e3181c76bd3. Epub 2009 Nov 21.
Atrial fibrillation (AF) occurs in 20%-50% of patients after cardiac surgery and is associated with increased morbidity and mortality. Corticosteroids are reported to decrease the incidence of postoperative AF, presumably by attenuating inflammation caused by surgery and cardiopulmonary bypass (CPB). We hypothesized that hemofiltration during CPB, which may attenuate inflammation, might decrease the incidence of AF after cardiac surgery.
This was a retrospective review of patients previously enrolled in a double-blind, placebo-controlled trial evaluating the effects of perioperative steroid therapy and hemofiltration during CPB on duration of postoperative mechanical ventilation. In that study, 192 patients undergoing cardiac surgery were randomized to 1 of 3 groups: controls (placebo), hemofiltration during CPB, or perioperative steroid therapy. Patient records were reviewed to determine the incidence of new onset AF defined as any electrocardiogram evidence of AF or AF diagnosed by the patients' clinicians.
Of the 192 enrolled patients, 3 were excluded for protocol violations and 4 were excluded for history of chronic AF. Data from 185 patients from the original study were available for review. Sixty patients (32%) had new onset AF after cardiac surgery. There was no difference among groups in the incidence of AF (control group, 21%; steroid group, 41%; hemofiltration group, 36%; P = 0.057 among groups). The only risk factor for the development of AF was age (mean age of patients with AF, 65.4 +/- 10.1 yr vs patients without AF, 61.4 +/- 11.5 yr; P = 0.024). When age, procedure type, and presence or absence of chronic obstructive pulmonary disease were controlled for in multivariate analysis, the difference among study groups remained nonsignificant (P = 0.108).
Perioperative corticosteroids or the use of hemofiltration during CPB did not decrease the incidence of AF after cardiac surgery. Further studies evaluating the efficacy and safety of perioperative corticosteroids for prevention of postoperative AF are warranted before their routine use can be recommended.
心房颤动（AF）在心脏手术后发生在 20%-50%的患者中，并与发病率和死亡率增加有关。皮质类固醇据报道可降低术后 AF 的发生率，推测是通过减轻手术和体外循环（CPB）引起的炎症。我们假设 CPB 期间的血液滤过可能会减轻炎症，从而降低心脏手术后 AF 的发生率。
这是一项对先前参加过一项双盲、安慰剂对照试验的患者进行的回顾性研究，该试验评估了围手术期类固醇治疗和 CPB 期间血液滤过对术后机械通气时间的影响。在该研究中，192 例接受心脏手术的患者被随机分为 3 组：对照组（安慰剂）、CPB 期间血液滤过或围手术期类固醇治疗。回顾患者记录以确定新发生的 AF 的发生率，定义为任何心电图证据的 AF 或患者临床医生诊断的 AF。
在纳入的 192 例患者中，有 3 例因违反方案而被排除，有 4 例因慢性 AF 病史而被排除。原始研究的 185 例患者的数据可用于回顾。60 例（32%）患者在心脏手术后出现新发生的 AF。各组 AF 的发生率无差异（对照组为 21%；类固醇组为 41%；血液滤过组为 36%；组间差异无统计学意义 P = 0.057）。AF 发生的唯一危险因素是年龄（AF 患者的平均年龄为 65.4 +/- 10.1 岁，无 AF 患者的平均年龄为 61.4 +/- 11.5 岁；P = 0.024）。当多变量分析中控制年龄、手术类型和是否存在慢性阻塞性肺疾病时，研究组之间的差异仍无统计学意义（P = 0.108）。
围手术期皮质类固醇或 CPB 期间使用血液滤过并不能降低心脏手术后 AF 的发生率。在推荐常规使用之前，需要进一步研究围手术期皮质类固醇预防术后 AF 的疗效和安全性。
