摘要
目的系统评价非体外循环冠状动脉旁路移植术后新发心房颤动(房颤)的危险因素。方法检索PubMed、EMbase、The Cochrane Library、中国知网、万方数据知识服务平台、维普网(VIP)、中国生物医学信息数据库(SinoMed),收集公开发表的非体外循环冠状动脉旁路移植术后新发房颤危险因素的相关文献,检索时限为建库至2022年9月。由2名研究者独立进行文献筛选、资料提取和质量评价。采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)评价纳入文献质量,采用Stata 12.0和RevMan 5.4软件进行Meta分析。结果共纳入文献18篇,包括6354例非体外循环冠状动脉旁路移植术患者。纳入文献的NOS评分为6~8分。Meta分析结果显示,年龄[MD=2.56,95%CI(1.61,3.52),P<0.001]、高血压[OR=1.77,95%CI(1.18,2.66),P<0.001]、EuroSCOREⅡ评分[MD=0.70,95%CI(0.34,1.06),P<0.001]、频发房性早搏或房性心动过速[OR=3.77,95%CI(2.13,6.68),P<0.001]、左房直径[MD=1.64,95%CI(0.26,3.03),P=0.010]、左室射血分数[MD=−1.84,95%CI(−2.85,−0.83),P<0.001]、合并右冠状动脉狭窄[OR=2.49,95%CI(1.29,4.81),P=0.006]、冠状动脉三支病变[OR=0.73,95%CI(0.54,0.97),P=0.030]、未使用β受体阻滞剂[OR=0.81,95%CI(0.69,0.96),P=0.010]、手术时间[MD=10.13,95%CI(8.15,12.10),P<0.001]、机械通气时间[OR=2.85,95%CI(1.79,3.91),P<0.001]是非体外循环冠状动脉旁路移植术后新发房颤的危险因素。结论高龄、高血压、EuroSCOREⅡ评分高、频发房性早搏或房性心动过速、左房增大、左室射血分数降低、合并右冠状动脉狭窄、冠状动脉三支病变、未使用β受体阻滞剂、手术时间延长、机械通气时间延长是非体外循环冠状动脉旁路移植术后新发房颤的危险因素。受纳入文献研究方法、内容和质量等因素限制,本研究结论需更多高质量研究予以验证。
Objective To systematically evaluate the risk factors for new-onset atrial fibrillation after off-pump coronary artery bypass grafting(OPCABG).Methods PubMed,EMbase,The Cochrane Library,CNKI,Wanfang,VIP,SinoMed were searched to collect published literature on risk factors for new-onset atrial fibrillation after OPCABG from inception to September 2022.Two authors independently screened,extracted data and evaluated the quality.The Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the included studies,and Stata 12.0 and RevMan 5.4 softwares were used for meta-analysis.Results A total of 18 researches were included,including 6354 patients of OPCABG.The NOS scores of the included studies were 6-8 points.Meta-analysis showed that age[MD=2.56,95%CI(1.61,3.52),P<0.001],hypertension[OR=1.77,95%CI(1.18,2.66),P<0.001],EuroSCOREⅡscore[MD=0.70,95%CI(0.34,1.06),P<0.001],frequent atrial premature beats or atrial tachycardia[OR=3.77,95%CI(2.13,6.68),P<0.001],left atrium diameter(LAD)[MD=1.64,95%CI(0.26,3.03),P=0.010],left ventricular ejection fraction(LVEF)[MD=−1.84,95%CI(−2.85,−0.83),P<0.001],right coronary stenosis[OR=2.49,95%CI(1.29,4.81),P=0.006],three-vessel coronary artery lesions[OR=0.73,95%CI(0.54,0.97),P=0.030],not usingβblockers[OR=0.81,95%CI(0.69,0.96),P=0.010],operation time[MD=10.13,95%CI(8.15,12.10),P<0.001],duration of mechanical ventilation[OR=2.85,95%CI(1.79,3.91),P<0.001]were risk factors for new-onset atrial fibrillation after OPCABG.Conclusion Advanced age,hypertension,high EuroSCOREⅡscore,frequent atrial premature beats or atrial tachycardia,increased LAD,decreased LVEF,right coronary stenosis,three-vessel coronary artery lesions,not usingβblockers,prolonged operation time and mechanical ventilation are risk factors for new-onset atrial fibrillation after OPCABG.Due to factors such as the methodology,content and quality of the included literature,the conclusion of this study need to be supported by more high-quality studies.
作者
木楠
何秋煜
陈名桂
邱寅龙
黎钰晴
王明欣
张晓璇
MU Nan;HE Qiuyu;CHEN Minggui;QIU Yinlong;LI Yuqing;WANG Mingxin;ZHANG Xiaoxuan(The Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou,510006,P.R.China;The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,510120,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2024年第8期1206-1214,共9页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
广东省科技厅海外名师项目
广东省中医药局课题(20212072)
广东省中医院中医药科学技术研究专项课题(YN2020HL03)。
