心脏瓣膜置换合并搭桥手术后的新发房颤危险因素分析及其对预后的影响

Analysis of the Risk Factors for Postoperative Atrial Fibrillation (POAF) Following Combined Valve Replacement and Coronary Artery Bypass Grafting (CABG) and Their Impact on the Prognosis

摘要: 目的：分析心脏瓣膜置换合并搭桥手术后的新发房颤危险因素分析及对预后的影响。方法：选取我院2019年01月至2024年4月期间收治的行心脏瓣膜置换合并搭桥手术者85例，根据患者是否新发房颤分为POAF组(n = 21)与非POAF组(n = 64)，收集接受心脏瓣膜置换联合冠状动脉搭桥手术患者的临床资料、术中操作细节、实验室指标及影像学参数，将上述变量作为自变量，采用多变量logistic回归模型分析POAF的独立危险因素。所有患者术后接受为期1年的标准化随访，主要终点事件包括心血管性死亡、心力衰竭再住院、缺血性卒中、心脑血管出血事件以及冠状动脉血运重建需求。通过门诊复查、电话随访及电子病历系统采集数据，评估此类患者并发POAF的预后影响。结果：85例行心脏瓣膜置换合并搭桥手术者中，出现POAF者21例，64例患者未出现POAF，POAF发生率为24.71%。本研究采用多因素Logistic回归模型，以年龄、静息心率、高血压史、糖尿病史、慢性肾病史、心功能NYHA分级、体外循环时间、主动脉阻断时间、血钾、血镁、血肌酐(Scr)、血浆NT-proBNP、肌酸激酶同工酶(CK-MB)、游离甲状腺激素(FT4)、左房内径(LAD)及左室射血分数(LVEF)为自变量，分析心脏瓣膜置换联合搭桥术后新发房颤(POAF)的独立危险因素。

Abstract: Objective: To analyze the risk factors for postoperative atrial fibrillation after cardiac valve replacement combined with coronary artery bypass grafting and its impact on prognosis. Methods: A total of 85 patients who underwent cardiac valve replacement combined with coronary artery bypass grafting in our hospital from January 2019 to April 2024 were selected. According to whether postoperative atrial fibrillation occurred, they were divided into the POAF group (n = 21) and the non-POAF group (n = 64). Clinical data, intraoperative operation details, laboratory indicators, and imaging parameters of patients receiving cardiac valve replacement combined with coronary artery bypass grafting were collected. The above variables were used as independent variables, and a multivariate logistic regression model was used to analyze the independent risk factors for POAF. All patients received a 1-year standardized follow-up. The main endpoint events included cardiovascular death, heart failure rehospitalization, ischemic stroke, cardiovascular and cerebrovascular hemorrhage events, and the need for coronary revascularization. Data were collected through outpatient review, telephone follow-up, and electronic medical record system to evaluate the prognostic impact of POAF in such patients. Results: Among 85 patients who underwent cardiac valve replacement combined with bypass surgery, 21 had POAF and 64 did not. The incidence of POAF was 24.71%. In this study, a multivariate logistic regression model was used, with age, resting heart rate, history of hypertension, history of diabetes, history of chronic kidney disease, NYHA cardiac function classification, cardiopulmonary bypass time, aortic cross-clamp time, serum potassium, serum magnesium, serum creatinine (Scr), plasma NT-proBNP, creatine kinase isoenzyme (CK-MB), free thyroxine (FT4), left atrial diameter (LAD), and left ventricular ejection fraction (LVEF) as independent variables to analyze the independent risk factors for postoperative atrial fibrillation (POAF) after cardiac valve replacement combined with bypass surgery.