Creswell L L, Schuessler R B, Rosenbloom M, Cox J L
Department of Surgery, Barnes Hospital, Washington University School of Medicine, St. Louis, MO 63110.
Ann Thorac Surg. 1993 Sep;56(3):539-49. doi: 10.1016/0003-4975(93)90894-n.
Between January 1, 1986, and December 31, 1991, 4,507 adult patients underwent cardiac surgical procedures requiring cardiopulmonary bypass. Of these patients, 3,983 patients who did not undergo operation for supraventricular tachycardia and who were in normal sinus rhythm preoperatively form the study group for the present study. Postoperatively, all patients were monitored continuously for the development of arrhythmias until the time of hospital discharge. The incidence of atrial arrhythmias requiring treatment for the most commonly performed operative procedures were as follows: coronary artery bypass grafting, 31.9%; coronary artery bypass grafting and mitral valve replacement, 63.6%; coronary artery bypass grafting and aortic valve replacement, 48.8%; and heart transplantation, 11.1%. For all patients considered collectively, the risk factors associated with an increased incidence of postoperative atrial arrhythmias (p < 0.05 by multivariate logistic regression) included increasing patient age, preoperative use of digoxin, history of rheumatic heart disease, chronic obstructive pulmonary disease, and increasing aortic cross-clamp time. Postoperative atrial fibrillation was associated with an increased incidence of postoperative stroke (3.3% versus 1.4%; p < 0.0005), increased length of hospitalization in the intensive care unit (5.7 versus 3.4 days; p = 0.001) and postoperative nursing ward (10.9 versus 7.5 days; p = 0.0001), increased incidence of postoperative ventricular tachycardia or fibrillation (9.2% versus 4.0%; p < 0.0005), and an increased need for placement of a permanent pacemaker (3.7% versus 1.6%; p < 0.0005). These data provide a basis for targeting specific patient subgroups for prospective, randomized trials of therapeutic modalities designed to decrease the incidence of postoperative atrial arrhythmias.
在1986年1月1日至1991年12月31日期间，4507例成年患者接受了需要体外循环的心脏外科手术。在这些患者中，3983例未接受室上性心动过速手术且术前为正常窦性心律的患者构成了本研究的研究组。术后，所有患者均持续监测心律失常的发生情况，直至出院。最常见手术操作中需要治疗的房性心律失常发生率如下：冠状动脉旁路移植术，31.9%；冠状动脉旁路移植术加二尖瓣置换术，63.6%；冠状动脉旁路移植术加主动脉瓣置换术，48.8%；以及心脏移植术，11.1%。总体而言，所有患者中与术后房性心律失常发生率增加相关的危险因素（多因素逻辑回归分析p<0.05）包括患者年龄增加、术前使用地高辛、风湿性心脏病史、慢性阻塞性肺疾病以及主动脉阻断时间延长。术后房颤与术后中风发生率增加相关（3.3%对1.4%；p<0.0005）、重症监护病房住院时间延长（5.7天对3.4天；p=0.001）以及术后护理病房住院时间延长（10.9天对7.5天；p=0.0001）、术后室性心动过速或颤动发生率增加（9.2%对4.0%；p<0.0005）以及永久性起搏器植入需求增加（3.7%对1.6%；p<0.0005）。这些数据为针对特定患者亚组进行旨在降低术后房性心律失常发生率的治疗方式的前瞻性随机试验提供了依据。
