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心肌血运重建手术中术后房颤的危险因素:15年经验总结

Risk Factors for Postoperative Atrial Fibrillation in Myocardial Revascularization Surgery: A 15-Year Experience.

作者信息

Bonilla-Bonilla Diana Marcela, Osorio-Toro Luis Miguel, Daza-Arana Jorge Enrique, Quintana-Ospina Jhon H, Ávila-Valencia Juan Carlos, Lozada-Ramos Heiler

机构信息

Internal Medicine Specialization Program, Department of Health, Universidad Santiago de Cali, Santiago de Cali 760001, Colombia.

Department of Research and Education, Clínica de Occidente SA, Santiago de Cali 760001, Colombia.

出版信息

J Clin Med. 2024 Aug 31;13(17):5171. doi: 10.3390/jcm13175171.

Abstract

Myocardial revascularization surgery (MRV) is a revascularization therapy for coronary artery disease aimed at improving survival conditions. Elderly patients with increased comorbidities undergoing MRV face challenges in preventing postoperative complications, including atrial fibrillation (AF), a common arrhythmia occurring in 40% of cases or even in 80% of cases if the procedure is combined with valve surgery. This study aimed to determine the risk factors associated with the appearance of postoperative AF (POAF) in patients undergoing isolated MRV. This is an epidemiological, retrospective, and analytical case-control study (90 cases and 360 controls). Mortality within the group of patients who presented with POAF in the study population was 15.5%, and 9.44% in the control group. Logistic regression showed an association of AF with the presurgical variables age >60 years and urgent/emergency surgery and the postsurgical variables cardiogenic shock, blood transfusion, pulmonary edema, pleural effusion, orotracheal reintubation, and mechanical ventilation time. Strategies should be proposed for the timely identification of risk factors and postoperative complications related to AF onset to avoid the increased morbidity and mortality associated with this type of arrhythmia during the postoperative period.

摘要

心肌血运重建手术(MRV)是一种针对冠状动脉疾病的血运重建疗法,旨在改善生存状况。合并症增多的老年患者接受MRV手术时,在预防术后并发症方面面临挑战,包括心房颤动(AF),这是一种常见的心律失常,在40%的病例中会出现,若该手术与瓣膜手术联合进行,甚至在80%的病例中会出现。本研究旨在确定接受单纯MRV手术的患者术后发生房颤(POAF)的相关危险因素。这是一项流行病学、回顾性分析病例对照研究(90例病例和360例对照)。研究人群中出现POAF的患者组死亡率为15.5%,对照组为9.44%。逻辑回归显示,房颤与术前变量年龄>60岁、急诊/紧急手术以及术后变量心源性休克、输血、肺水肿、胸腔积液、经口气管再插管和机械通气时间有关。应提出策略,以便及时识别与房颤发作相关的危险因素和术后并发症,避免术后因这类心律失常导致发病率和死亡率增加。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f361/11395854/900f4973eaf3/jcm-13-05171-g001.jpg

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