肺移植术后心房颤动发生的危险因素研究

摘要

Objective:Although atrial fibrillation or flutter(AF) was thought to occur commonly after lung transplantation,little was known about the epidemiology,risk factors or clinical significance.The ame of the study was to determine the incidence,clinical predictors of AF after lung transplant.Methods:The records of 108 patients who underwent lung transplantation from August 2002 to June 2011.Multivariate logistic regression analysis was performed to define the predictors for posttransplant AF.Results:Indications for transplant included idiopathic pulmonary fibrosis (IPF)in 53.93%,COPD in 22.47%,silicosis and bronchiectasis 5.62% each.The transplants were bilateral(62.16%) and single lung(30.77%).The mean age of the patients was 51.6 years old(range,18 to 74 years old;median,52 years old).Postoperative AF within 14 days of transplant occurred in 39 patients(43.82%),with a mean onset of (4.1±3.0) days( x ±SD).Significant predictors of AF were as follow:age≥years old(OR,3.2;P=0.02);IPF(OR,2.7;P=0.01);enlarged left atrium(LA) on echocardiography(OR,4.1;P=0.05),and number of postoperative vasopressors(OR,1.7;P=0.01);Patients with AF had longer hospital stays(40.2±51.0) days VS (31.1±21.2) days,P=0.04,were more likely to undergo tracheostomy(OR,3.8;P=0.0003),and had more in-hospital deaths(OR,3.1;P=0.0005) than patients without AF.Conclusion:AF was a frepuent complication after lung transplant.Advanced age,IPF,enlarged LA,and use of postoperation vasopressors increase the risk for developing AF.The development of posttransplant AF is associated with significantly prolonged hospital stay and increased mortality.%　　目的：肺移植术后心房颤动(房颤)及心房扑动(房扑)为常见并发症,但是在流行病学、危险因素或者临床意义上却少有报道.本研究对肺移植术后房颤的发病率、临床预测指标进行研究.方法：2002年8月~2011年6月有108名患者行肺移植术.应用多变量Logic回归分析来预测肺移植术后房颤的发生.结果：特发性肺纤维化53.93%,COPD22.47%,矽肺和支气管扩张各5.62%.双肺移植62.16%,单肺移植30.77%.平均年龄51.6(18~74岁,中位数52岁)岁.术后14天内发生房颤39例(43.82%),平均(4.1±3.0)天( x ±SD).有效预测指标：年龄大于等于50岁(OR,3.2；P=0.02),IPF(OR,2.7；P=0.01),超声心动图左房大(OR,4.1；P=0.05),术后升压药物的应用(OR,1.7；P=0.01).与术后无房颤发生患者相比,术后发生房颤的患者住院时间延长[(40.2±51.0)天VS(31.1±21.2)天,P=0.04],行气管造口术可能性更大(OR,3.8；P=0.0003),并且院内死亡风险更高(OR,3.1；P=0.0005).结论：房颤是肺移植术后常见并发症.高龄、IPF、左房大、升压药的应用是房颤发生的高危因素.术后肺移植的发生延长了住院时间、增加了死亡率.