Hemofiltration During Cardiopulmonary Bypass Does Not Decrease the Incidence of Atrial Fibrillation After Cardiac Surgery
Hemofiltration During Cardiopulmonary Bypass Does Not Decrease the Incidence of Atrial Fibrillation After Cardiac Surgery
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DOI：
10.1213/ane.0b013e3181c76bd3
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发表时间：
2010-02-01
影响因子：
5.7
通讯作者：
Oliver, William C.
中科院分区：
文献类型：
--
作者：
Mauermann, William J.;Nuttall, Gregory A.;Oliver, William C.
背景：心脏手术后20%-50%的患者发生心房颤动（AF），并与发病率和死亡率增加相关。据报道，皮质类固醇可降低术后AF的发生率，可能是通过减轻手术和心肺转流（CPB）引起的炎症。我们假设，血液滤过在体外循环，这可能会减轻炎症，可能会降低AF的发生率后，心脏surgery.METHODS：这是一个回顾性的审查，以前参加了一个双盲，安慰剂对照试验，评价围手术期类固醇治疗和血液滤过在体外循环的影响，术后机械通气的持续时间。在该研究中，192例接受心脏手术的患者被随机分配到3组中的1组：对照组（安慰剂）、CPB期间血液滤过组或围手术期类固醇治疗组。患者记录进行审查，以确定新发AF的发病率定义为任何心电图证据的AF或AF诊断的患者的clinics.RESULTS：在192例入组患者中，3例被排除的方案违反和4例被排除的历史慢性AF。数据从185例患者的原始研究可供审查。60例患者（32%）在心脏手术后新发AF。组间房颤发生率无差异（对照组，21%;类固醇组，41%;血液滤过组，36%;组间P = 0.057）。房颤发生的唯一风险因素是年龄（房颤患者的平均年龄为65.4 ± 10.1。年与无房颤患者相比，61.4 +/- 11.5年; P = 0.024）。当年龄，程序类型，和慢性阻塞性肺疾病的存在或不存在控制在多变量分析中，研究组之间的差异仍然不显着（P = 0.108）。结论：围手术期皮质类固醇激素或使用血液滤过在体外循环心脏手术后并没有降低AF的发病率。在推荐常规使用皮质类固醇之前，需要进一步研究评价围手术期皮质类固醇预防术后房颤的有效性和安全性。（Anesth Analg 2010;110：329-34）
BACKGROUND: Atrial fibrillation (AF) Occurs in 20%-50% of patients after cardiac surgery and is associated with increased morbidity and mortality. Corticosteroids are reported to decrease the incidence of postoperative AF, presumably by attenuating inflammation caused by surgery and cardiopulmonary bypass (CPB). We hypothesized that hemofiltration during CPB, which may attenuate inflammation, might decrease the incidence of AF after cardiac surgery.METHODS: This was a retrospective review of patients previously enrolled in a double-blind, placebo-controlled trial evaluating the effects of perioperative steroid therapy and hemofiltration during CPB on duration of postoperative mechanical ventilation. In that study, 192 patients undergoing cardiac surgery were randomized to 1 of 3 groups: controls (placebo), hemofiltration during CPB, or perioperative steroid therapy. Patient records were reviewed to determine the incidence of new onset AF defined as any electrocardiogram evidence of AF or AF diagnosed by the patients' clinicians.RESULTS: Of the 192 enrolled patients, 3 were excluded for protocol violations and 4 were excluded for history of chronic AF. Data from 185 patients from the original study were available for review. Sixty patients (32%) had new onset AF after cardiac surgery. There was no difference among groups in the incidence of AF (control group, 21%; steroid group, 41%; hemofiltration group, 36%; P = 0.057 among groups). The only risk factor for the development of AF was age (mean age of patients with AF, 65.4 +/- 10.1. yr vs patients Without AF, 61.4 +/- 11.5 yr; P = 0.024). When age, procedure type, and presence or absence of chronic obstructive pulmonary disease were controlled for in multivariate analysis, the difference among study groups remained nonsignificant (P = 0.108).CONCLUSIONS: Perioperative corticosteroids or the use of hemofiltration during CPB did not decrease the incidence of AF after cardiac Surgery. Further studies evaluating the efficacy and safety of perioperative corticosteroids for prevention of postoperative AF are warranted before their routine use can be recommended. (Anesth Analg 2010;110:329-34)