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后心包切开术。它能降低冠状动脉旁路移植术后房颤的发生率吗?

The posterior pericardiotomy. Does it reduce the incidence of postoperative atrial fibrillation after coronary artery bypass grafting?

作者信息

Kongmalai Peerapat, Karunasumetta Chananya, Kuptarnond Chusak, Prathanee Sompop, Taksinachanekij Suthep, Intanoo Worawit, Wongbuddha Chawalit, Senthong Vichai

出版信息

J Med Assoc Thai. 2014 Oct;97 Suppl 10:S97-104.

Abstract

Atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass graft surgery (CABG). Posterior pericardiotomy (PP) has been reported toreduce pericardial effusion, AF triggel; and reduce the length of hospital stay and hospital costs without significant complications. A total of 20 patients, diagnosed with coronary artery diseases to be treated by an elective or urgent CABG between August and December 2013, were randomly divided into two groups; 10 patients received PP (PP group) and 10 patients did not receive PP (control group). The incidence ofAF was equal (40% in both groups). Early pericardial effusion was slightly higher in the PP group (PP 70%, control 60%; p = 1.00). The incidence of left pleural effusion and pneumonia were higher in the PP group than in the control. Moreover, one patient in the PP group developed perioperative myocardial infarction (MI) that required intensive care with medication. The duration of ICU stay of the PP group was significantly longer than that of the control group. In conclusion, PP did not reduce the incidence of postoperative AF nor did early pericardial effusion. Rather, PP increased post-operative complications such asperioperative MI, left pleural effusion, and pneumonia resulting in the prolonged ICU stay.

摘要

心房颤动(AF)是冠状动脉旁路移植术(CABG)后最常见的心律失常。据报道,后心包切开术(PP)可减少心包积液、房颤触发因素,并缩短住院时间和降低住院费用,且无明显并发症。2013年8月至12月期间,共有20例被诊断为冠状动脉疾病并计划接受择期或急诊CABG治疗的患者被随机分为两组;10例患者接受PP(PP组),10例患者未接受PP(对照组)。房颤的发生率相同(两组均为40%)。PP组早期心包积液略高于对照组(PP组70%,对照组60%;p = 1.00)。PP组左侧胸腔积液和肺炎的发生率高于对照组。此外,PP组有1例患者发生围手术期心肌梗死(MI),需要药物重症监护。PP组在重症监护病房(ICU)的停留时间明显长于对照组。总之,PP既没有降低术后房颤的发生率,也没有减少早期心包积液。相反,PP增加了围手术期MI、左侧胸腔积液和肺炎等术后并发症,导致ICU停留时间延长。

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