Keller M, Meierhenrich R
Klinik für Anästhesie und Intensivmedizin, Diakonie-Klinikum Stuttgart, Rosenbergstr. 38, 70176, Stuttgart, Deutschland.
Anaesthesist. 2017 Oct;66(10):786-794. doi: 10.1007/s00101-017-0334-0.
Atrial fibrillation is the most common new onset arrhythmia in patients hospitalized with sepsis; however, there are no specific treatment guidelines and the ideal therapeutic approaches still remain unclear.
To begin with the current state of knowledge concerning the underling mechanisms, the incidence and prognostic impact of new onset atrial fibrillation during sepsis are presented. Then a possible therapeutic algorithm for the special situation of sepsis is derived with respect to the currently existing atrial fibrillation guidelines. Finally necessary future research topics are outlined.
A systematic literature search was conducted in MEDLINE. All publications (reviews and studies) relevant for the summary of the current knowledge regarding new onset atrial fibrillation in septic patients were included.
The underlying patchomechanism is primarily systemic inflammation. Approximately 8% of patients with sepsis and more than 20% of patients with septic shock develop new onset atrial fibrillation. The occurrence of atrial fibrillation is associated with increased morbidity and mortality. The necessity of rhythm control therapy is dependent on the hemodynamic stability. The success rate of electrical cardioversion can be increased by the administration of amiodarone. The necessity of systemic anticoagulation is based on the individual risk of thromboembolism.
Further research is needed to unveil the optimal therapeutic strategies for patients with new onset atrial fibrillation during sepsis.
心房颤动是脓毒症住院患者中最常见的新发心律失常；然而，目前尚无具体的治疗指南，理想的治疗方法仍不明确。
首先介绍脓毒症期间新发心房颤动的潜在机制、发病率及预后影响等当前的知识状况。然后根据现有的心房颤动指南，推导针对脓毒症特殊情况的可能治疗方案。最后概述未来必要的研究课题。
在MEDLINE数据库中进行系统的文献检索。纳入所有与总结脓毒症患者新发心房颤动当前知识相关的出版物（综述和研究）。
潜在的病理机制主要是全身炎症。约8%的脓毒症患者和超过20%的脓毒性休克患者会发生新发心房颤动。心房颤动的发生与发病率和死亡率增加相关。节律控制治疗的必要性取决于血流动力学稳定性。使用胺碘酮可提高电复律的成功率。全身抗凝的必要性基于个体血栓栓塞风险。
需要进一步研究以揭示脓毒症期间新发心房颤动患者的最佳治疗策略。
