心脏手术后心脏自主神经调节和PR间期测定可预测心房颤动增加的风险
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Cardiac autonomic regulation and PR interval determination for enhanced atrial fibrillation risk prediction after cardiac surgery.
背景与目的
心脏自主神经调节和P波特征的变化与心房颤动的发生有关。本研究的目的是评估术前非侵入性心脏自主神经调节和PR间期的确定是否可以确定心脏手术后新发房颤的风险患者。
方 法
150例接受择期冠状动脉旁路移植术、主动脉瓣置换术，接受慢性β受体阻滞剂的患者在手术前一天从20分钟高分辨率心电图测定RR，PR和QT间期以及线性和非线性心率变异性参数。
结 果
31名患者（21％）发生术后心房颤动。相对于窦性心律组，在心房颤动组，动脉高血压更高，年龄越大，EuroSCORE II越高，心率变异性指数越高（pNN50：9±20对4±10，p = 0.050），PR间期越短（156±23），发现趋势波动分析降低（DFA1,0.96±0.36对1.11 ±0.30ms; p = 0.032）。Logistic模型证实PR间期，DFA1和年龄是术后心房颤动最佳的术前预测因素。
结 论
心脏手术后发生心房颤动的患者术前有出现严重的心脏自主神经紊乱和短PR间期。观察到的状态表现为改变的心率调节和心律失常发生基础，并且与术后心房颤动的风险增加密切相关。
原始文献摘要
BACKGROUND Changes in cardiac autonomic regulation and P-wave characteristics are associated with the occurrence of atrial fibrillation. The purpose of this study was to evaluate whether combined preoperative non-invasive determination of cardiac autonomic regulation and PR interval allows for the identification of patients at risk of new-onset atrial fibrillation after cardiac surgery.
METHODS RR, PR and QT intervals, and linear and non-linear heart rate variability parameters from 20 min high-resolution electrocardiographic recordings were determined one day before surgery in 150 patients on chronic beta blockers undergoing elective coronary artery bypass grafting, aortic valve replacement, or both, electively.
RESULTS Thirty-one patients (21%) developed postoperative atrial fibrillation. In the atrial fibrillation group, more arterial hypertension, a greater age, a higher EuroSCORE II, a higher heart rate variability index (pNN50: 9 ± 20 vs. 4 ± 10, p = 0.050), a short PR interval (156 ± 23 vs. 173 ± 31 ms; p = 0.011), and a reduced short-term scaling exponent of the detrended fluctuation analysis (DFA1, 0.96 ± 0.36 vs. 1.11 ± 0.30 ms; p = 0.032) were found compared to the sinus rhythm group. Logistic regression modeling confirmed PR interval, DFA1 and age as the strongest preoperative predictors of postoperative atrial fibrillation (area under the receiver operating characteristic curve = 0.804).
CONCLUSIONS Patients developing atrial fibrillation after cardiac surgery presented with severe cardiac autonomic derangement and a short PR interval preoperatively. The observed state characterizes both altered heart rate regulation and arrhythmic substrate and is strongly related to an increased risk of postoperative atrial fibrillation.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：符校魁 编辑：何幼芹 审校：王贵龙