Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery
Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery
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DOI：
10.1093/bja/aem067
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发表时间：
2007-05-01
影响因子：
9.8
通讯作者：
Mizobe, T.
中科院分区：
文献类型：
--
作者：
Hosokawa, K.;Nakajima, Y.;Mizobe, T.
背景资料。术后房颤(AF)是心胸手术后最常见的并发症之一，与中风风险增加和住院时间延长有关。术后房颤的病理生理机制尚不确定，其预防仍不尽如人意。以往的许多研究都探讨了体外循环冠状动脉搭桥术(CABG)后房颤的预测因素，但在非体外循环冠状动脉搭桥术(CABG)后的报道很少。这项前瞻性观察研究的目的是阐明非体外循环冠状动脉旁路移植术后房颤的预测因素。采用单因素分析研究围手术期因素与房颤的关系。将显著变量纳入逐步Logistic回归模型，以确定它们对AF发生的独立影响。房颤发生率为32%。房颤使患者出院时间延长3天(P<；0.01)。多因素逐步回归分析显示，年龄[优势比(OR)每10年增加1.44，95%可信区间(CI)1.06~1.95]、术中平均心脏温度(OR 1.64；95%CI 1.05~2.56)、重症监护病房平均心脏指数(OR 0.37；95%CI 0.19~0.71)、术中液体平衡(OR 0.96/100-ml增加；95%CI 0.93~0.99)是AF发生的独立预测因素。我们目前的研究结果表明，年龄、术中液体平衡和术后心脏指数与非体外循环冠脉搭桥术后房颤的发生有关。
Background. Postoperative atrial fibrillation (AF) is one of the most common complications after cardiothoracic surgery and is associated with an increased risk of stroke, and longer hospital stay. The pathophysiology of postoperative AF is uncertain, and its prevention remains unsatisfactory. Many previous studies have examined the predictors of AF after on-pump coronary artery bypass graft surgery (CABG), but there are few reports after off-pump CABG.Methods. The aim of the present prospective observational study, in which 296 consecutive patients were enrolled, was to elucidate the predictors of AF after off-pump CABG. The association of perioperative factors with AF was investigated using univariate analysis. Significant variables were included into a stepwise logistic regression model to ascertain their independent influence on the occurrence of AF.Results. The incidence of AF was 32%. AF prolonged the time until patients were fit for discharge by 3 days (P < 0.01). Stepwise multivariate analysis identified increasing age [odds ratio (OR) 1.44 per 10-yr increase; 95% confidence interval (CI) 1.06-1.95], intraoperative average core temperature (OR 1.64; 95% CI 1.05-2.56), the average cardiac index in the intensive care unit (OR 0.37; 95% CI 0.19-0.71), and intraoperative fluid balance (OR 0.96 per 100-ml increase; 95% CI 0.93-0.99) as independent predictors of postoperative AF.Conclusion. Our present findings indicate that ageing, the intraoperative fluid balance, and postoperative cardiac index are associated with the onset of AF after off-pump CABG.