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二尖瓣修复术后心律失常及短期预后的相关临床因素:一项回顾性队列研究。

Clinical factors associated with arrhythmia and short-term prognosis following mitral valve repair: a retrospective cohort study.

作者信息

Zhu Yuxiang, Jing Wenbin, Lv Pengfei, Zhu Yubao, Liu Zhigang

机构信息

Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China.

出版信息

Cardiovasc Diagn Ther. 2022 Feb;12(1):114-122. doi: 10.21037/cdt-21-400.

DOI:10.21037/cdt-21-400
PMID:35282674
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8898689/
Abstract

BACKGROUND

Postoperative arrhythmia (POA) is one of the common and serious postoperative complications. This retrospective study was conducted to investigate the clinical factors associated with POA and its short-term prognosis following mitral valve repair.

METHODS

A total of 618 patients receiving mitral valve repair between January 2015 and November 2020 in our hospital were included in this retrospective study, including 318 males and 300 females and aged 53.9±9.3 years. The patients were grouped into arrhythmia and non-arrhythmia groups and investigated for risk factors associated with the prognosis of POA using multivariate logistic regression based on their clinical data.

RESULTS

POA was observed in 314 (50.8%) patients and atrial fibrillation (AF) was the most frequent (43.3%) type of POA. Compared with non-arrhythmia patients, arrhythmia patients had significantly longer time to use vasoactive drug use, longer intensive care unit (ICU) stay and longer hospital stay. In addition, the incidence of postoperative heart failure was significantly higher (P<0.05). Logistic regression analysis showed that preoperative arrhythmia [odds ratio (OR) =9.17; 95% confident interval (CI): 4.49-18.10], postoperative pain (OR =4.70; 95% CI: 1.55-6.12) and postoperative hypoxemia (OR =3.25; 95% CI: 1.04-6.28) were independently associated with POA.

CONCLUSIONS

This study demonstrates that the incidence of arrhythmia is relatively high after mitral valve repair and is associated with preoperative arrhythmia, postoperative pain and postoperative hypoxemia.

摘要

背景

术后心律失常(POA)是常见且严重的术后并发症之一。本回顾性研究旨在探讨二尖瓣修复术后与POA相关的临床因素及其短期预后。

方法

本回顾性研究纳入了2015年1月至2020年11月在我院接受二尖瓣修复的618例患者,其中男性318例,女性300例,年龄53.9±9.3岁。将患者分为心律失常组和非心律失常组,并根据其临床数据,采用多因素logistic回归分析POA预后的相关危险因素。

结果

314例(50.8%)患者出现POA,其中房颤(AF)是最常见的POA类型(43.3%)。与非心律失常患者相比,心律失常患者使用血管活性药物的时间明显更长,重症监护病房(ICU)停留时间和住院时间更长。此外,术后心力衰竭的发生率明显更高(P<0.05)。logistic回归分析显示,术前心律失常[比值比(OR)=9.17;95%置信区间(CI):4.49-18.10]、术后疼痛(OR =4.70;95%CI:1.55-6.12)和术后低氧血症(OR =3.25;95%CI:1.04-6.28)与POA独立相关。

结论

本研究表明,二尖瓣修复术后心律失常的发生率相对较高,且与术前心律失常、术后疼痛和术后低氧血症有关。

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本文引用的文献

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What is the role of metabolic syndrome and obesity for postoperative atrial fibrillation after coronary bypass grafting?代谢综合征和肥胖对冠状动脉旁路移植术后心房颤动的作用是什么?
BMC Cardiovasc Disord. 2019 Jun 17;19(1):147. doi: 10.1186/s12872-019-1130-3.
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Postoperative atrial fibrillation: mechanisms, manifestations and management.术后心房颤动:机制、表现和管理。
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Oxidative stress and atrial fibrillation: an update.氧化应激与心房颤动:研究进展。
Free Radic Res. 2018 Dec;52(11-12):1199-1209. doi: 10.1080/10715762.2018.1500696. Epub 2018 Sep 10.
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Risks of on-pump coronary artery bypass grafting surgery in patients with chronic obstructive pulmonary disease due to sulfur mustard.硫芥所致慢性阻塞性肺疾病患者行体外循环冠状动脉旁路移植术的风险
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Risk Factors of Recurrence of Atrial Fibrillation (AF) After AF Surgery in Patients With AF and Mitral Valve Disease.房颤合并二尖瓣疾病患者房颤手术后房颤复发的危险因素
Semin Thorac Cardiovasc Surg. 2018;30(3):271-278. doi: 10.1053/j.semtcvs.2018.01.004. Epub 2018 Feb 2.
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Hypothyroidism is a Risk Factor for Atrial Fibrillation after Coronary Artery Bypass Graft.甲状腺功能减退是冠状动脉旁路移植术后发生心房颤动的一个危险因素。
Braz J Cardiovasc Surg. 2017 Nov-Dec;32(6):475-480. doi: 10.21470/1678-9741-2017-0080.
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BMC Anesthesiol. 2017 Dec 2;17(1):163. doi: 10.1186/s12871-017-0455-7.
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Indian J Anaesth. 2017 Sep;61(9):760-767. doi: 10.4103/ija.IJA_379_17.
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