文章摘要
心脏瓣膜手术术后心律失常的危险因素与短期预后分析
Risk factors and short-term prognosis of arrhythmia after cardiac valve surgery
  
DOI：10.12089/jca.2019.04.010
中文关键词: 心脏瓣膜手术  术后心律失常  房颤  危险因素  短期预后
英文关键词: Cardiac valve surgery  Postoperative arrhythmia  Atrial fibrillation  Risk factors  Short-term prognosis
基金项目:
作者单位E-mail
代思思 410008,长沙市,中南大学湘雅医院麻醉科  
李曼 四川省骨科医院麻醉科(李曼)  
张延荣 410008,长沙市,中南大学湘雅医院麻醉科  
张帆 410008,长沙市,中南大学湘雅医院麻醉科  
张重 410008,长沙市,中南大学湘雅医院麻醉科  
王锷 410008,长沙市,中南大学湘雅医院麻醉科  
贺正华 410008,长沙市,中南大学湘雅医院麻醉科 xymz99@163.com 
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中文摘要:
      
目的 了解心脏瓣膜手术术后心律失常的发生情况,探讨其发生的危险因素及短期预后。
方法 回顾2015年7月至2016年11月在本院择期行心脏瓣膜手术的患者206例,男100例，女106例，年龄18～70岁,BMI 15～32 kg/m2,NYHA心功能分级Ⅱ—Ⅳ级,ASA Ⅱ—Ⅳ级。根据患者手术后是否发生心律失常分为两组：心律失常组和非心律失常组。分析比较两组患者术前、术中及术后的临床资料,评估术后心律失常的发生情况及预后情况,采用多元Logistic回归分析术后发生心律失常的相关危险因素。
结果 心脏瓣膜手术术后共有124例(60.2％)患者发生心律失常,其中房颤发生率(48.5％)最高。与非心律失常组比较,心律失常组术后血管活性药物使用时间、ICU停留时间及住院时间明显延长,术后心衰发生率明显增高(P<0.05)。术后发生心律失常的独立危险因素有术前心律失常(OR=9.62,95％CI 4.79～19.30)、术后疼痛(OR=3.90,95％CI 1.85～8.22)及术后低氧血症(OR=2.55,95％CI 1.04～6.22)。
结论 术前重视心律失常的控制,术后予以足够的镇痛,及时纠正低氧血症,可以减少术后心律失常的发生,缩短患者ICU停留时间及住院时间,减少其他并发症,从而改善患者预后。
英文摘要:
      
Objective To investigate the incidence, risk factors and short-term prognosis of arrhythmia after cardiac valve surgery.
Methods A total of 206 patients undergoing elective cardiac valve surgery from July 2015 to November 2016, 100 males and 106 females, aged 18-70 years, having a BMI 15-32 kg/m2, NYHA cardiac function Ⅱ-Ⅳ and ASA physical status Ⅱ-Ⅳ, were retrospectively analyzed in this study. According to patients rhythm after surgery, they were divided into two groups, the arrhythmia group and the non arrhythmia group. The preoperative, intraoperative and postoperative clinical data of the two groups were analyzed and compared statistically. The incidence and short-term prognosis were evaluated as well. Multivariate logistic regression was used to analyze the risk factors associated with postoperative arrhythmia.
Results A total of 124 patients had arrhythmia after cardiac valve surgery, the incidence rate was 60.2％. The incidence of atrial fibrillation was the highest in all arrhythmia (48.5％). Compared with non postoperative arrhythmic group, the postoperative vasoactive drug support time, ICU stay time and hospitalization time was respectively longer in postoperative arrhythmic group (P<0.05). In addition, the incidence of postoperative heart failure was higher (P<0.05). The independent risk factors for postoperative arrhythmia included preoperative arrhythmia (OR=9.62,95％CI 4.79-19.30), postoperative pain (OR=3.90,95％CI 1.85-8.22) and postoperative hypoxemia (OR=2.55,95％CI 1.04-6.22).
Conclusion Preoperative attention to the control of arrhythmia, adequate postoperative analgesia and timely correction of hypoxemia are helpful to reduce postoperative arrhythmia, shorten the time of ICU stay and hospitalization, prevent other complications, and improve the prognosis of patients.
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