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肺癌手术后的心房颤动:预测、预防及抗凝管理

Atrial Fibrillation after Lung Cancer Surgery: Prediction, Prevention and Anticoagulation Management.

作者信息

Semeraro Gennaro Carmine, Meroni Carlo Ambrogio, Cipolla Carlo Maria, Cardinale Daniela Maria

机构信息

Cardioncology Unit, European Institute of Oncology, IRCCS, 20145 Milan, MI, Italy.

Cardiology Department, European Institute of Oncology, IRCCS, 20145 Milan, MI, Italy.

出版信息

Cancers (Basel). 2021 Aug 9;13(16):4012. doi: 10.3390/cancers13164012.

Abstract

Atrial fibrillation (AF) is a common complication of the early postoperative period of various types of surgery, including that for lung cancer. Although induced by the homeostatic alterations related to surgery, there is evidence that it is not a mere stand-alone transitory event, but it represents a relevant complication of surgery, bearing considerable prognostic consequences. Different methods have therefore been explored to predict the occurrence of postoperative atrial fibrillation (POAF) and prevent it. In particular, the age among clinical factors, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), as a marker, have proven to be good predictors, and the use of beta-blockers or amiodarone in primary prevention seems to reduce its incidence significantly. There is growing evidence that POAF significantly increases the risk of stroke and global mortality in the long term; therefore, it should be managed in the same way as spontaneous atrial fibrillation. In this review, we will present the strongest evidence found so far and the most recent findings regarding the management of POAF, with a special focus on patients undergoing thoracic surgery for lung cancer.

摘要

心房颤动(AF)是包括肺癌手术在内的各类手术术后早期常见的并发症。尽管它是由与手术相关的内环境稳态改变所诱发,但有证据表明它并非仅仅是一个孤立的短暂事件,而是手术的一种相关并发症,具有相当大的预后影响。因此,人们探索了不同方法来预测术后心房颤动(POAF)的发生并加以预防。特别是,临床因素中的年龄以及作为标志物的脑钠肽N末端前体激素(NT-proBNP)已被证明是良好的预测指标,并且在一级预防中使用β受体阻滞剂或胺碘酮似乎能显著降低其发生率。越来越多的证据表明,从长期来看,POAF会显著增加中风风险和总体死亡率;因此,应与自发性心房颤动一样对其进行管理。在本综述中,我们将呈现目前为止发现的最有力证据以及关于POAF管理的最新研究结果,特别关注接受肺癌胸外科手术的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4cc4/8394120/513d19022d28/cancers-13-04012-g001.jpg

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