Department of General Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
Am J Surg. 2010 Nov;200(5):601-5. doi: 10.1016/j.amjsurg.2010.07.019.
Perioperative atrial arrhythmias (PAAs) in noncardiothoracic patients have poorly defined risk factors and management.
The surgical intensive care unit database was queried for patients who developed PAAs from 2008 to 2009. Demographics, comorbidities, preoperative data (electrocardiography, chest x-rays, laboratory results), medications, intraoperative variables, management, and outcomes of atrial arrhythmias were collected. Controls were randomly chosen in a 3:1 ratio. Comparisons were performed using χ² tests, Student's t tests, or nonparametric comparisons as appropriate. Multivariate logistic regression was performed.
Five hundred sixty-one patients were admitted to the surgical intensive care unit. Three hundred fifty-four (63%) had noncardiothoracic surgery, and 30 (8.5%) developed PAAs. The mean age of patients with PAAs was 66 ± 7.3 years, compared with 64 ± 11 years for controls (P = NS), with most patients undergoing general (60%) and vascular (33%) surgery. PAA patients were more likely to have coronary artery disease (P = .029), cardiomegaly (P = .011), and premature atrial contractions (P = .016) and to take aspirin (P = .010). On multivariate logistic regression, predictors of atrial arrhythmias were premature atrial contractions, preoperative hypokalemia, intraoperative adverse events, and cardiomegaly. Most PAA patients received amiodarone (63%). Ten percent required electrical cardioversion, and 26% received anticoagulation. PAA patients had significantly longer intensive care unit lengths of stay (P = .032).
Coronary artery disease, cardiomegaly, hypokalemia, and premature atrial contractions were significantly associated with PAAs in noncardiothoracic patients. Prospective studies are needed to define treatment guidelines.
非心胸外科患者围术期房性心律失常（PAAs）的危险因素和处理方法尚未明确。
检索 2008 年至 2009 年外科重症监护病房数据库，以确定发生 PAAs 的患者。收集患者的人口统计学、合并症、术前数据（心电图、胸部 X 线、实验室结果）、药物、术中变量、房性心律失常的处理和结果。按照 3:1 的比例随机选择对照组。采用 χ²检验、Student's t 检验或非参数比较进行比较。采用多变量逻辑回归分析。
561 例患者入住外科重症监护病房，其中 354 例（63%）接受非心胸外科手术，30 例（8.5%）发生 PAAs。PAAs 患者的平均年龄为 66±7.3 岁，对照组为 64±11 岁（P=NS），大多数患者接受全身麻醉（60%）和血管手术（33%）。PAAs 患者更可能患有冠状动脉疾病（P=0.029）、心脏扩大（P=0.011）和房性期前收缩（P=0.016），并服用阿司匹林（P=0.010）。多变量逻辑回归分析显示，房性心律失常的预测因素为房性期前收缩、术前低钾血症、术中不良事件和心脏扩大。大多数 PAAs 患者接受胺碘酮（63%）治疗。10%需要电复律，26%需要抗凝治疗。PAAs 患者的重症监护病房住院时间明显延长（P=0.032）。
非心胸外科患者中，冠状动脉疾病、心脏扩大、低钾血症和房性期前收缩与 PAAs 显著相关。需要前瞻性研究来确定治疗指南。
