Pehkonen E, Honkonen E, Mäkynen P, Kataja M, Tarkka M
Department of Thoracic and Cardiovascular Surgery, Tampere University Hospital, Finland.
Thorac Cardiovasc Surg. 1998 Jun;46(3):115-20. doi: 10.1055/s-2007-1010206.
It is assumed that stenosis of the right coronary artery (RCA) predisposes CABG patients, by way of incomplete atrial myocardial protection, to postoperative atrial fibrillation (AF). Sixty patients with high-grade RCA lesion were randomized into four groups according to the technique of delivery of cold blood cardioplegia: antegrade, retrograde, retrograde without catheter cuff, and combined antegrade and retrograde. As controls, 34 patients without RCA lesion were randomized to receive antegrade or retrograde cardioplegia. Postoperative atrial fibrillation episodes were recorded. Patients with RCA lesion were more prone to develop AF; odds ratio (OR)=3.75 (95% confidence interval [CI]=1.22-11.5). Retrograde delivery in these patients was more often associated with AF, OR=4.97 (95% CI = 1.02-24.1). Other risk factors for AF were an increasing number of preoperative infarcts (p < 0.05) and more advanced coronary artery disease (p < 0.05). Prolonged stay in the intensive care unit (p < 0.001) and occurrence of postoperative ventricular tachycardia (p < 0.05) were associated with AF. RCA stenosis and retrograde cardioplegia delivery in RCA-affected patients were risk factors for postoperative atrial fibrillation. Retrograde cardioplegia may offer poorer protection at the atrial level.
据推测，右冠状动脉（RCA）狭窄通过不完全的心房心肌保护作用，使冠状动脉旁路移植术（CABG）患者易发生术后心房颤动（AF）。60例患有严重RCA病变的患者根据冷血心脏停搏液的输注技术被随机分为四组：顺行、逆行、无导管套囊逆行和顺行与逆行联合。作为对照，34例无RCA病变的患者被随机接受顺行或逆行心脏停搏液。记录术后心房颤动发作情况。患有RCA病变的患者更易发生AF；优势比（OR）=3.75（95%置信区间[CI]=1.22 - 11.5）。这些患者中逆行输注更常与AF相关，OR=4.97（95%CI = 1.02 - 24.1）。AF的其他危险因素包括术前梗死灶数量增加（p < 0.05）和更严重的冠状动脉疾病（p < 0.05）。在重症监护病房停留时间延长（p < 0.001）和术后室性心动过速的发生（p < 0.05）与AF相关。RCA狭窄和对受RCA影响的患者进行逆行心脏停搏液输注是术后心房颤动的危险因素。逆行心脏停搏液在心房水平可能提供较差的保护。
