在线办公
期刊论坛
主 管
中国人民解放军总医院
主 办
中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
编 辑
中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
传真:010-66936756
E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
谢旻,王东信,李双玲.重症监护病房非心脏手术患者术后新发房颤危险因素[J].中华老年多器官疾病杂志,2018,17(6):401~406
重症监护病房非心脏手术患者术后新发房颤危险因素
Risk factors of new-onset postoperative atrial fibrillation in critically ill patients after non-cardiac surgery
投稿时间:2017-11-09  修订日期:2017-12-08
DOI:10.11915/j.issn.1671-5403.2018.06.090
中文关键词:  心房颤动;围手术期;高龄;术后并发症
英文关键词:atrial fibrillation; perioperative period; very old; postoperative complications
基金项目:国家临床重点专科建设项目(2012-649)
作者单位E-mail
谢旻 北京大学第一医院重症医学科,北京100034  
王东信 北京大学第一医院重症医学科,北京100034 wangdongxin@hotmail.com 
李双玲 北京大学第一医院重症医学科,北京100034  
摘要点击次数: 467
全文下载次数: 323
中文摘要:
      目的 调查重症监护病房(ICU)非心脏手术患者术后新发房颤(POAF)的发生情况,分析其危险因素及对近期预后的影响。方法 采用回顾性、病例配对的方法。在2011年1月至2013年12月期间收住ICU的非心脏手术后成年患者2586例中,筛查术后住院期间新发房颤病例。按照1∶[KG-*2]2的比例,选择年龄、性别和手术部位相同的病例作为对照组。采用SPSS 21.0统计软件对数据进行分析。多因素logistic回归分析筛选危险因素。比较2组患者的近期结局。结果 2.7%(71/2586)出现术后新发房颤。高龄(年龄≥75岁)及胸科手术患者术后新发房颤发生率高。在术后新发房颤患者中,77.5%(55/71)出现在术后3 d以内,仅33.8%(24/71)患者有不适主诉。在配对人群中,脓毒症(OR=11.81,95%CI 1.72~81.00,P=0.012)、低钾血症(OR=19.48,95%CI 2.31~164.09,P=0.006)、术后急性充血性心力衰竭(OR=9.91,95%CI 1.92~51.22,P=0.006)及新发其他类型心律失常(OR=20.32,95%CI 3.51~117.55,P=0.001)是术后新发房颤的独立危险因素。术后新发房颤伴随机械通气时间及ICU停留时间延长及住院死亡率增高。结论 非心脏手术入ICU的患者中术后新发房颤发生率为2.7%,多见于高龄(≥75岁)和胸科手术患者。在病例配对人群中,脓毒症、急性充血性心力衰竭、低钾血症和新发非房颤心律失常是术后新发房颤的危险因素。新发房颤伴随预后恶化。
英文摘要:
      Objective To investigate the occurrence of new-onset postoperative atrial fibrillation (POAF) in intensive care unit (ICU) patients after non-cardiac surgery, and to analyze its risk factors and impact on short-time outcomes. Methods A retrospective nested case-control study was conducted among the 2586 cases who underwent non-cardiac procedures and then admitted into ICU in the period from January 2011 to December 2013. Those with new-onset POAF during hospitalization were screened out. Control patients who were matched in age, gender and location of surgery were selected at a 1∶[KG-*2]2 ratio. SPSS statistics 21.0 was used to perform the statistical analysis. Risk factors were screened with multivariate logistic regression analysis. Early postoperative outcomes were compared between the 2 groups. Results Among the subjects, 2.7%(71/2586) developed new-onset POAF. The incidence was quite higher in those very old (≥75 years old) and in those after intra-thoracic surgery. In the patients who developed new-onset POAF, 77.5%(55/71) occurred within 3 d postoperatively, and only 33.8%(24/71) complained of discomfort. Sepsis (OR=11.81, 95%CI 1.72-81.00, P=0.012), hypokalemia (OR=19.48,5%CI 2.31-164.09, P=0.006), postoperative acute congestive heart failure (OR=9.91, 95%CI 1.92-51.22, P=0.006), and new-onset non-atrial fibrillation arrhythmias (OR=20.32,5%CI 3.51-117.55,P=0.001) were independent risk factors for new-onset POAF in the matched patients. Higher in-hospital mortality was associated with longer mechanical ventilation and ICU stay in these patients. Conclusion The incidence of new-onset POAF is 2.7% in the patients admitted to ICU after non-cardiac surgery. The condition is more common in the very elderly (≥75 years old) and those after intra-thoracic surgery. Sepsis, acute congestive heart failure, hypokalemia and new-onset non-AF arrhythmias are independent risk factors of POAF in the matched patients. New-onset POAF is deteriorated with worse outcomes.
查看全文    下载PDF阅读器
关闭