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| 心脏手术中左心室舒张功能与术后新发心房颤动的相关性 |
| Correlation analysis between intraoperative left ventricular diastolic function in cardiac surgery and postoperative new-onset atrial fibrillation |
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| DOI：10.12089/jca.2025.11.005 |
| 中文关键词: 术后新发心房颤动 心脏手术 左心室舒张功能 经食管超声心动图 |
| 英文关键词: Postoperative new-onset atrial fibrillation Cardiac surgery Left ventricular diastolic function Transesophageal echocardiography |
| 基金项目:江苏省科技厅社会发展面上项目（BE2023749）；江苏省中医药科技发展计划项目（MS2022151） |
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| 中文摘要: |
目的：探讨心脏手术中左心室舒张功能与术后新发心房颤动（POAF）的相关性。
方法：选择择期行心肺转流（CPB）心脏手术患者53例，男37例，女16例，年龄18～80岁，BMI 18.5～24.0 kg/m2，ASA Ⅱ—Ⅳ级。于胸骨劈开后CPB前及CPB停机后30 min经食管超声心动图（TEE）测量左心室舒张功能，包括二尖瓣E/A值、E峰减速时间、A波持续时间、肺静脉S/D比值及Ar波持续时间以及等容舒张时间。根据是否发生POAF将患者分为两组：POAF组和非POAF组。采用多因素Logistic回归分析左心室舒张功能与心脏手术POAF的相关性。
结果： 有16例（30.1%）患者发生POAF。单因素分析显示，年龄、术毕时CRP、胸骨劈开后CPB前二尖瓣E/A值及A波持续时间以及肺静脉Ar波持续时间与心脏手术POAF的发生相关（P<0.05）。多因素Logistic回归分析显示，胸骨劈开后CPB前二尖瓣E/A值及A波持续时间是心脏手术POAF发生的影响因素。胸骨劈开后CPB前E/A值预测心脏手术POAF的AUC为0.853（95%CI 0.731～0.975），敏感性为0.729，特异性为0.937，截断值为1.21。胸骨劈开后CPB前二尖瓣A波持续时间预测心脏手术POAF的AUC为0.784 （95%CI 0.658～0.909），敏感性为0.703，特异性为0.812，截断值为151.3 ms。
结论：胸骨劈开后CPB前二尖瓣E/A值及A波持续时间可作为心脏手术POAF的预测指标。 |
| 英文摘要: |
Objective: To explore the correlation between intraoperative left ventricular diastolic function and postoperative new-onset atrial fibrillation (POAF) in cardiac surgery patients.
Methods: Fifty-three patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB), 37 males and 16 females, aged 18-80 years, BMI 18.5-24.0 kg/m2, and ASA physical status Ⅱ-Ⅳ, were included. Left ventricular diastolic function, including the E/A ratio, the E wave deceleration time, and the A wave duration of the mitral valve, the S/D ratio and the Ar wave duration of the pulmonary vein, and the isovolumetric relaxation time were measured by transesophageal echocardiography (TEE) after sternotomy and before CPB and 30 minutes after CPB cessation. The patients were divided into two groups: POAF group and non-POAF group, according to whether POAF occurred. The correlation between left ventricular diastolic function and POAF after cardiac surgery was analyzed by multivariate logistic regression analysis.
Results: A total of 16 patients (30.1%) developed POAF. Age, CRP at the end of surgery, the mitral E/A ratio and the A wave duration after sternotomy and before CPB, and pulmonary vein Ar wave duration after sternotomy and before CPB were associated with POAF (P < 0.05). Multivariate logistic regression analysis showed that the mitral E/A ratio and the A wave duration were influencing factors for POAF in cardiac surgery. For the E/A ratio, the area under the curve (AUC) was 0.853 (95% CI 0.731-0.975), the sensitivity and specificity were 0.729 and 0.937, respectively, and the cutoff value was 1.21. For the A wave duration after sternotomy and before CPB, the AUC was 0.784 (95% CI 0.658-0.909), the sensitivity and specificity were 0.703 and 0.812, respectively, and the cutoff value was 151.3 ms.
Conclusion: The mitral E/A ratio and the time of A wave duration after sternotomy and before CPB are predictive indicator for POAF following cardiac surgery. |
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