Douglas P S, Hirshfeld J W, Edmunds L H
Circulation. 1985 Sep;72(3 Pt 2):II159-63.
One hundred eighteen consecutive patients undergoing valve replacement for aortic stenosis were analyzed to determine the incidence of and predisposing factors to postoperative atrial tachyarrhythmias. Univariate and multivariate analyses were performed on 70 clinical, hemodynamic, radiographic, electrocardiographic, operative, and postoperative variables. Forty-seven patients (40%) experienced atrial tachyarrhythmias at a median of 3 days after surgery (70% atrial fibrillation, 22% atrial flutter, and 6% junctional tachycardia). Preoperative descriptors associated with an increased prevalence of atrial tachyarrhythmias were age 70 years or older (p less than .02), mitral regurgitation (p less than .002), history of paroxysmal atrial fibrillation (p less than .03), or antiarrhythmic therapy (p less than .006), diabetes mellitus (p less than .01), and elevated pulmonary systolic, mean, and capillary wedge pressures (p less than .02, p less than .007, p less than .005). Postoperative descriptors were prolonged respirator therapy (p less than .001), use of catecholamines (p less than .01) or vasodilators (p less than .05), and prolonged stay in the intensive care unit (p less than .04). Multivariate analysis of these 12 variables showed advanced age, diabetes mellitus, and prolonged respirator use to be independently associated with atrial tachycardias and to predict them with a sensitivity of 62% and a specificity of 77%. Anticipation of atrial arrhythmias in patients with specific clinical descriptors may be used to guide prophylactic therapy.
对118例因主动脉瓣狭窄接受瓣膜置换术的连续患者进行分析，以确定术后房性快速心律失常的发生率及易感因素。对70项临床、血流动力学、影像学、心电图、手术及术后变量进行单因素和多因素分析。47例患者（40%）在术后中位时间3天出现房性快速心律失常（70%为房颤，22%为房扑，6%为交界性心动过速）。与房性快速心律失常患病率增加相关的术前指标包括年龄70岁及以上（p<0.02）、二尖瓣反流（p<0.002）、阵发性房颤病史（p<0.03）、抗心律失常治疗（p<0.006）、糖尿病（p<0.01）以及肺收缩压、平均压和毛细血管楔压升高（p<0.02、p<0.007、p<0.005）。术后指标包括呼吸支持治疗时间延长（p<0.001）、使用儿茶酚胺（p<0.01）或血管扩张剂（p<0.05）以及在重症监护病房停留时间延长（p<0.04）。对这12个变量进行多因素分析显示，高龄、糖尿病和呼吸支持治疗时间延长与房性快速心律失常独立相关，预测其敏感性为62%，特异性为77%。对具有特定临床指标的患者预测房性心律失常，可用于指导预防性治疗。
