[冠状动脉旁路移植术后心房颤动发生的相关因素]

[Factors Associated With Development of Atrial Fibrillation After Coronary Artery Bypass Grafting].

作者信息

Rubanenko O A, Fatenkov O V, Kuznetsov D V, Semagin A P, Khokhlunov S M, Duplyakov D V

机构信息

Samara State Medical University, Samara, Russia.

Samara Regional Cardiology Dispensary, Samara, Russia.

出版信息

Kardiologiia. 2016 Sep;56(9):50-54. doi: 10.18565/cardio.2016.9.50-54.

DOI:10.18565/cardio.2016.9.50-54

PMID:28290864

Abstract

PURPOSE

to identify factors associated with development of atrial fibrillation (AF) in the early postoperative period of coronary artery bypass grafting (CABG).

METHODS

A total of 376 patients with ischemic heart disease who underwent CABG were enrolled in the study.

RESULTS

During the observation period AF occurred in 74 patients (19.7%, 93% men, mean age 64.0+/-6.4 years), an average of 3.6+/-2 days after surgery. Multivariate regression analysis showed that odds ratio (OR) for AF in patients with age >59 years was 1.5 (95% confidence interval [CI], 1.1-3.5; p=0.04), aortic cross-clamping time >43 min - 2.4 (95% CI, 1.05-6.2; p=0.03), left atrial dimension (LAD) >39 mm - 5.0 (95% CI, 2.0-12.6; p=0.0006), left ventricular ejection fraction (LVEF) <51% - 3.6 (95% CI, 1.6-8.3, p=0.002). During ROC - analysis the high sensitivity was observed for LAD >39 mm (82%, =0.001), high specificity - for LVEF <51% (80%, =0.0009), highest positive likelihood ratio for LVEF <51% - 2.56 (=0.0009), greatest negative likelihood ratio for LAD >39 mm - 0.31 (=0.001).

CONCLUSION

In our study, the risk of AF development in the early postoperative period of CABG depended on the patients age, left atrial size, left ventricular ejection fraction, and aortic cross-clamping time during CABG.

摘要

目的

确定冠状动脉旁路移植术（CABG）术后早期发生心房颤动（AF）的相关因素。

方法

本研究共纳入376例接受CABG的缺血性心脏病患者。

结果

在观察期内，74例患者（19.7%，男性占93%，平均年龄64.0±6.4岁）发生AF，平均在术后3.6±2天。多因素回归分析显示，年龄>59岁患者发生AF的比值比（OR）为1.5（95%置信区间[CI]，1.1 - 3.5；p = 0.04），主动脉阻断时间>43分钟为2.4（95% CI，1.05 - 6.2；p = 0.03），左心房内径（LAD）>39 mm为5.0（95% CI，2.0 - 12.6；p = 0.0006），左心室射血分数（LVEF）<51%为3.6（95% CI，1.6 - 8.3，p = 0.002）。在受试者工作特征（ROC）分析中，LAD>39 mm的敏感性较高（82%，p = 0.001），LVEF<51%的特异性较高（80%，p = 0.0009），LVEF<51%的阳性似然比最高为2.56（p = 0.0009），LAD>39 mm的阴性似然比最大为0.31（p = 0.001）。