Polanczyk C A, Goldman L, Marcantonio E R, Orav E J, Lee T H
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Intern Med. 1998 Aug 15;129(4):279-85. doi: 10.7326/0003-4819-129-4-199808150-00003.
Few recent data are available on risk factors for perioperative supraventricular arrhythmia (SVA) after noncardiac surgery or on the effect of SVA on clinical outcomes.
To determine the incidence, clinical correlates, and effect on length of stay of perioperative SVA in patients having major noncardiac surgery.
Prospective cohort study.
Urban tertiary care teaching hospital.
4181 patients 50 years of age or older who had major, nonemergency, noncardiac procedures and were in sinus rhythm at the preoperative evaluation.
Preoperative clinical data, postoperative enzyme data, serial electrocardiograms, and clinical outcomes were collected prospectively. Outcomes were 1) SVA that persisted or led to treatment and 2) increase in length of stay attributable to SVA.
Perioperative SVA occurred in 317 patients (7.6%); it occurred in 83 patients (2.0%) during surgery and in 256 (6.1%) after surgery. Independent preoperative correlates of SVA were male sex (odds ratio [OR], 1.3 [95% CI, 1.0 to 1.7]), age 70 years or older (OR, 1.3 [CI, 1.0 to 1.7]), significant valvular disease (OR, 2.1 [CI, 1.2 to 3.6]), history of SVA (OR, 3.4 [CI, 2.4 to 4.8]) or asthma (OR, 2.0 [CI, 1.3 to 3.1]), congestive heart failure (OR, 1.7 [CI, 1.1 to 2.7]), premature atrial complexes on preoperative electrocardiography (OR, 2.1 [CI, 1.3 to 3.4]), American Society of Anesthesiologists class III or IV (OR, 1.4 [CI, 1.1 to 1.9]), and type of procedure: abdominal aortic aneurysm (OR, 3.9 [CI, 2.4 to 6.3]) or abdominal (OR, 2.5 [CI, 1.7 to 3.6]), vascular (OR, 1.6 [CI, 1.1 to 2.4]), and intrathoracic (OR, 9.2 [CI, 6.7 to 13]) procedures. Among patients who had intrathoracic surgery, those receiving digoxin were at lower risk (OR, 0.2 [CI, 0.04 to 0.8]) for SVA than those not receiving digoxin. Patients with perioperative acute cardiac and noncardiac events had high relative risks for SVA. Supraventricular arrhythmia was associated with a 33% increase in length of stay after adjustment for other clinical data (P < 0.001).
In this cohort, SVA was common after noncardiac surgery and was associated with prolonged length of stay.
关于非心脏手术后围手术期室上性心律失常（SVA）的危险因素或SVA对临床结局的影响，目前几乎没有最新数据。
确定接受大型非心脏手术患者围手术期SVA的发生率、临床相关因素及其对住院时间的影响。
前瞻性队列研究。
城市三级护理教学医院。
4181例年龄在50岁及以上、接受大型非急诊非心脏手术且术前评估为窦性心律的患者。
前瞻性收集术前临床数据、术后酶学数据、系列心电图及临床结局。结局指标为：1）持续存在或导致治疗的SVA；2）因SVA导致的住院时间延长。
317例患者（7.6%）发生围手术期SVA；其中83例（2.0%）在手术期间发生，256例（6.1%）在术后发生。SVA的独立术前相关因素包括男性（比值比[OR]，1.3[95%可信区间（CI），1.0至1.7]）、70岁及以上（OR，1.3[CI，1.0至1.7]）、严重瓣膜病（OR，2.1[CI，1.2至3.6]）、SVA病史（OR，3.4[CI，2.4至4.8]）或哮喘病史（OR，2.0[CI，1.3至3.1]）、充血性心力衰竭（OR，1.7[CI，1.1至2.7]）、术前心电图显示房性早搏（OR，2.1[CI，1.3至3.4]）、美国麻醉医师协会分级III或IV级（OR，1.4[CI，1.1至1.9]）以及手术类型：腹主动脉瘤手术（OR，3.9[CI，2.4至6.3]）或腹部手术（OR，2.5[CI，1.7至3.6]）、血管手术（OR，1.6[CI，1.1至2.4]）和胸腔内手术（OR，9.2[CI，6.7至13]）。在接受胸腔内手术的患者中，服用地高辛者发生SVA的风险低于未服用地高辛者（OR，0.2[CI，0.04至0.8]）。围手术期发生急性心脏和非心脏事件的患者发生SVA的相对风险较高。在对其他临床数据进行调整后，室上性心律失常与住院时间延长33%相关（P<0.001）。
在该队列中，非心脏手术后SVA很常见，且与住院时间延长相关。
