Supraventricular arrhythmia in patients having noncardiac surgery: Clinical correlates and effect on length of stay
Supraventricular arrhythmia in patients having noncardiac surgery: Clinical correlates and effect on length of stay
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DOI：
10.7326/0003-4819-129-4-199808150-00003
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发表时间：
1998-08-15
影响因子：
39.2
通讯作者：
Lee, TH
中科院分区：
文献类型：
--
作者：
Polanczyk, CA;Goldman, L;Lee, TH
背景资料：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对临床结局的影响的最新数据很少。目的：确定重大非心脏手术患者围手术期SVA的发生率、临床相关因素和对住院时间的影响。设计：前瞻性队列研究。设置：城市三级护理教学医院。参与者：4181例50岁或以上的患者，他们接受了重大、非急诊、非心脏手术，术前评估时处于窦性心律。测量：前瞻性收集术前临床数据、术后酶数据、系列心电图和临床结局。结果：1）持续存在或导致治疗的SVA和2）由于SVA导致的住院时间延长。结果：317例患者（7.6%）发生围手术期SVA; 83例患者（2.0%）发生在手术期间，256例患者（6.1%）发生在手术后。SVA的独立术前相关因素为男性（比值比[OR]，1.3 [95% CI，1.0 - 1.7]），年龄≥ 70岁（OR，1.3 [CI，1.0 - 1.7]），严重瓣膜疾病（OR，2.1 [CI，1.2 - 3.6]），SVA病史（OR，3.4 [CI，2.4 - 4.8]）或哮喘（OR，2.0 [CI，1.3 - 3.1]），充血性心力衰竭（OR，1.7 [CI，1.1 - 2.7]），术前心电图显示房性早搏（OR，2.1 [CI，1.3 - 3.4]），美国麻醉医师学会III级或IV级（OR，1.4 [CI，1.1 - 1.9]）和手术类型：腹主动脉瘤（OR，3.9 [CI，2.4 - 6.3]）或腹部（OR，2.5 [CI，1.7 - 3.6]）、血管（OR，1.6 [CI，1.1 - 2.4]）和胸内（OR，9.2 [CI，6.7 - 13]）手术。在接受胸内手术的患者中，接受地高辛治疗的患者发生SVA的风险（OR，0.2 [CI，0.04 - 0.8]）低于未接受地高辛治疗的患者。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。校正其他临床资料后，室上性心律失常与住院时间增加33%相关（P < 0.001）。结论：在该队列中，非心脏手术后SVA常见，与住院时间延长相关。
Background: 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.Objective: To determine the incidence, clinical correlates, and effect on length of stay of perioperative SVA in patients having major noncardiac surgery.Design: Prospective cohort study.Setting: Urban tertiary care teaching hospital.Participants: 4181 patients 50 years of age or older who had major, nonemergency, noncardiac procedures and were in sinus rhythm at the preoperative evaluation.Measurements: 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.Results: 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).Conclusions: In this cohort, SVA was common after noncardiac surgery and was associated with prolonged length of stay.