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中华卫生应急电子杂志

中华卫生应急电子杂志 ›› 2019, Vol. 05 ›› Issue (03) : 136 -140. doi: 10.3877/cma.j.issn.2095-9133.2019.03.003

所属专题： 文献；

论著

电复律治疗心脏瓣膜手术后心房颤动或心房扑动的疗效及影响因素
陈小芳1, 王东进1,†()   
  1. 1. 210008　江苏南京，南京大学医学院附属鼓楼医院心胸外科
  • 收稿日期:2019-01-14 出版日期:2019-06-18
  • 通信作者: 王东进
  • 基金资助:
    江苏省十三五"科教强卫工程"医学重点学科(ZDXKA2016019)

Effect and influencing factors of cardioversion on atrial fibrillation or atrial flutter in patients after cardiac valve surgery

Xiaofang Chen1, Dongjin Wang1,†()   

  1. 1. Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2019-01-14 Published:2019-06-18
  • Corresponding author: Dongjin Wang
  • About author:
    Corresponding author: Wang Dongjin, Email:
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陈小芳, 王东进. 电复律治疗心脏瓣膜手术后心房颤动或心房扑动的疗效及影响因素[J/OL]. 中华卫生应急电子杂志, 2019, 05(03): 136-140.

Xiaofang Chen, Dongjin Wang. Effect and influencing factors of cardioversion on atrial fibrillation or atrial flutter in patients after cardiac valve surgery[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2019, 05(03): 136-140.

目的

分析电复律治疗心脏瓣膜手术后患者发生心房颤动或心房扑动的疗效及影响因素。

方法

选取南京鼓楼医院心胸外科2011年1月至2014年6月收治的心脏瓣膜病术后发生心房颤动或心房扑动并行电复律治疗的91例患者进行回顾性分析。在重症监护病房(ICU)心电(ECG)监测下，全身麻醉后以双向波100～150 J能量对患者行同步电复律，复律成功的患者辅以口服胺碘酮3个月。统计患者接受电复律治疗的即时成功率以及随访6个月的窦性心律稳定率，以电复律即时成功与否将患者分成两组，电复律成功组和电复律不成功组，并分析可能影响电复律即时成功的影响因素。91例患者中，男性39例，女性52例；年龄26 ～ 76岁，平均(54.3±11.1)岁。有75例(82.4%)即时转为窦性心律；随访1～6个月，64例(85.3%)维持窦性心律。

结果

术前纽约心脏病协会(NYHA)心功能分级低、血清B型脑钠肽(BNP)水平低、左房内径较小、心房扑动、外科术前心房颤动病程较短患者的电复律成功率高，而手术方式以及电复律时间距离外科手术的时间对电复律成功率无明显影响。左心房内径是心脏外科术后患者心房颤动或心房扑动电复律治疗成功的独立预测因素。

结论

电复律是心脏瓣膜术后心房颤动或心房扑动的有效的治疗方法，电复律的即时成功率是82.4%，随访1～6个月的窦性心律维持率是85.3%。电复律前左心房内径是电复律成功的独立预测因素。

关键词: 心脏瓣膜疾病, 心房颤动, 心房扑动, 心脏电复律
Objective

To analyze the effect and influencing factor of cardioversion on atrial fibrillation or atrial flutter and the factors affecting the success of cardioversion in patients after heart valve surgery.

Methods

Ninety-one patients with atrial fibrillation or atrial flutter treated with cardioversion after heart valve surgery in Nanjing Gulou Hospital from January 2011 to June 2014 were retrospectively analyzed. Under intensive care unit (ICU) ECG monitoring, patients received synchronous cardioversion with bi-directional wave energy of 100 J -150 J after general anesthesia. Successful patients received oral amiodarone for 3 months. The immediate success rate of cardioversion and the sinus rhythm stability rate of follow-up for 1 to 6 months were counted. The patients were divided into two groups according to whether the cardioversion was successful or not: the successful cardioversion group and the unsuccessful cardioversion group, and the influencing factors that might affect the immediate success of cardioversion were analyzed.

Results

Among 91 patients, 39 were males and 52 were females, ranging in age from 26 to 76 years, with an average age of (54.3+ 11.1) years. Seventy-five patients (82.4%) immediately converted to sinus rhythm, and 64 patients (85.3%) maintained sinus rhythm after 1 to 6 months of follow-up. Low NYHA class, low BNP level, small left atrial diameter, atrial flutter and short duration of atrial fibrillation before surgery had higher success rate of cardioversion, but the operation method and the time distance between surgery and cardioversion had no significant effect on the success of cardioversion. Univariate and multivariate logistic regression analyses showed that left atrial diameter is an independent predictor of successful cardioversion.

Conclusion

Cardioversion is an effective method for patients with atrial fibrillation or flutter after cardiac valve surgery. Left atrial diameter before cardioversion is an independent predictor of successful cardioversion.

Key words: Heart valvular disease, Atrial fibrillation, Atrial flutter, Cardioversion
表1 心脏瓣膜外科手术后继发心房颤动或心房扑动患者的基本临床特征[例(%)]
组别 例数 性别(例，男/女) 年龄(岁，±s) NYHA心功能分级(级，±s) 距离外科手术时间(月，±s) 电复律前BNP(pg/mL，±s) 电复律前心率(次/分，(x±s) 电复律前LAD内径(cm，±s)
电复律成功组 75 33/42 53.3±11.1 2.0±0.8 12.2±26.1 231.1±215.5 86.5±19.5 5.3±0.7
电复律不成功组 16 6/10 59.1±10.2 2.9±0.5 6.9±5.7 492.3±288.7 93.9±22.2 6.4±0.6
t/χ2值 ? 0.23 －1.9 －5.6 1.6 －3.4 －1.2 －6.3
P值 ? >0.05 >0.05 <0.05 >0.05 <0.05 >0.05 <0.05
组别 例数 手术方式 术中行RFCA 心房颤动
MVR＋TVP AVR＋MVP＋TVP BVR＋TVP MVP＋TVP 术前发生率 术前病程(月，±s) 转复后复发
电复律成功组 75 28(37.3%) 6(8.0%) 33(44.0%) 8(10.7%) 56(74.7%) 60(80.0%) 43.7±47.2 11(14.7%)
电复律不成功组 16 8(50.0%) 0(0%) 6(37.5%) 2(12.5%) 16(100%) 16(100%) 84.8±75.2 16(100%)
t/χ2值 ? 0.35 1.11 0.23 0.35 5.12 3.83 －2.1 46.02
P值 ? >0.05 >0.05 >0.05 >0.05 <0.05 >0.05 <0.05 <0.05
表2 以电复律成功与否为因变量的单变量Logistic回归分析结果
影响因素 B Wald P值 OR值 95%CI
心律失常(心房颤动/心房扑动) 3.226 9.262 <0.05 25.179 3.153～201.061
NYHA心功能分级 －1.865 11.607 <0.05 0.155 0.053～0.453
电复律前血清BNP水平 －0.004 9.371 <0.05 0.996 0.994～0.999
电复律前左心房内径 －2.932 16.455 <0.05 0.053 0.013～0.220
术前心房颤动病程 －0.012 6.222 <0.05 0.989 0.980～0.998
表3 以复律成功与否为应变量的多变量Logistic回归分析结果
影响因素 B Wald P值 OR值 95%CI
心律失常(心房颤动/房扑心房扑动) 1.807 2.109 >0.05 6.089 0.690～96.970
电复律前左心房内径 －2.564 9.994 <0.05 0.077 0.017～0.414
NYHA心功能分级 －0.750 0.941 >0.05 0.472 0.103～1.750
电复律前血清BNP水平 －0.002 0.621 >0.05 0.998 0.995～1.002
术前房颤心房颤动病程 －0.008 1.186 >0.05 0.992 0.977～1.007
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