Department of Burn and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
Department of Burn and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
Burns. 2022 Aug;48(5):1092-1096. doi: 10.1016/j.burns.2022.04.012. Epub 2022 May 10.
Atrial fibrillation is a well-documented complication following cardiac surgery. It is associated with increased inpatient and long-term mortality. There have been few prior studies on perioperative atrial fibrillation following burn surgery in severely burned patients. The purpose of this study was to identify the incidence, predictors, and prognosis of perioperative atrial fibrillation after burn surgery in severely burned patients.
Patients aged older than 18 years with 30% burned total body surface area (TBSA) were enrolled in this study. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the preoperative electrocardiogram were excluded. We reviewed medical records retrospectively, and the data of 214 patients were studied.
A total of 214 critically ill burned patients and 1132 operations were available for analysis during the 5-year study period; 12 (1.1%) patients were diagnosed with newly developed atrial fibrillation after a burn operation, of whom 4 patients showed paroxysmal atrial fibrillation (all related to surgical stimulation) and none changed to persistent atrial fibrillation. The incidence of perioperative atrial fibrillation was associated with TBSA%, full-thickness TBSA%, and hypertension. Multiple logistic regression analysis indicated that TBSA% (OR=13.851, P < 0.001) and full-thickness TBSA% (OR=15.223, P = 0.018) were independent predictors for developing perioperative atrial fibrillation. All of our patients had at least one risk factor, with blood volume variation or burn sepsis occurring most commonly. Perioperative atrial fibrillation developed after a median of 0 days after burn surgery. Three patients died, and the causes of death were noncardiovascular events such as sepsis and multiple organ failure.
Atrial fibrillation was a relatively rare complication among severely burned patients admitted to surgery and was associated with TBSA% and full thickness TBSA%. All of our patients exhibited at least one of the modifiable risk factors for atrial fibrillation, confirming the importance of optimization of electrolytes and fluid status and limitation of sympathetic activation.
心房颤动是心脏手术后有充分记录的并发症。它与住院期间和长期死亡率增加有关。在严重烧伤患者的烧伤手术后围手术期心房颤动方面，先前的研究很少。本研究的目的是确定严重烧伤患者烧伤手术后围手术期心房颤动的发生率、预测因素和预后。
本研究纳入了年龄大于 18 岁、烧伤总面积（TBSA）超过 30%的患者。排除有既往心房颤动病史或术前心电图有心房颤动的患者。我们回顾性地审查了病历，研究了 214 例患者的数据。
在 5 年的研究期间，共有 214 例危重病烧伤患者和 1132 例手术可用于分析；12 例（1.1%）患者在烧伤手术后被诊断为新发心房颤动，其中 4 例为阵发性心房颤动（均与手术刺激有关），无一例转为持续性心房颤动。围手术期心房颤动的发生率与 TBSA%、全层 TBSA%和高血压有关。多因素逻辑回归分析表明，TBSA%（OR=13.851，P<0.001）和全层 TBSA%（OR=15.223，P=0.018）是发生围手术期心房颤动的独立预测因素。我们所有的患者都至少有一个危险因素，最常见的是血容量变化或烧伤脓毒症。心房颤动在烧伤手术后中位数 0 天发生。3 例患者死亡，死因是非心血管事件如脓毒症和多器官功能衰竭。
心房颤动是接受手术治疗的严重烧伤患者中相对罕见的并发症，与 TBSA%和全层 TBSA%有关。我们所有的患者都表现出至少一个可改变的心房颤动危险因素，证实了优化电解质和液体状态以及限制交感神经激活的重要性。
