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心脏外科手术后房颤的研究进展
作者:年福来  汪黎明 
单位:南京医科大学附属南京医院(南京市心血管病医院) 心胸血管外科, 江苏 南京 210006
关键词:心房颤动 心脏外科手术 病理生理学基础 危险因素 治疗 综述 
分类号:R654.2
出版年·卷·期(页码):2019·47·第五期(619-623)
摘要:

心房颤动(atrial fibrillation,AF)是临床中最常见的心律失常,其往往会造成严重的并发症,而心脏外科术后出现心房颤动(postoperative atrial fibrillation,POAF)更是如此。POAF是众多不良后果的独立预测因子,包括中风、出血、感染、肝肾肺等多脏器衰竭、心脏骤停、脑部并发症、永久起搏器放置以及多因素下30 d和6个月死亡率。POAF的预防和治疗给广大临床医师的工作提出了一个巨大挑战,但到目前为止,结果并不理想。本文作者综述了POAF发生的病理生理学基础、危险因素以及治疗的临床指南,并讨论了进一步研究的新途径。

参考文献:

[1] FRENDL G,SODICKSON A C,CHUNG M K,et al.2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures[J].J Thorac Cardiovasc Surg,2014,148:e153-193.
[2] PHILIP I,BERROETA C,LEBLANC I.Perioperative challenges of atrial fibrillation[J].Curr Opin Anaesthesiol,2014,27:344-352.
[3] SHEN J,LALL S,ZHENG V,et al.The persistent problem of new-onset postoperative atrial fibrillation:a single-institution experience over two decades[J].J Thorac Cardiovasc Surg,2011,141:559-570.
[4] ECHAHIDI N,PIBAROT P,O'HARA G,et al.Mechanisms,prevention,and treatment of atrial fibrillation after cardiac surgery[J].J Am Coll Cardiol,2008,51:793-801.
[5] 庄燕,陈明龙.房颤的射频消融治疗[J].东南大学学报(医学版),2014,33(4):531-536.
[6] TURAGAM M K,DOWNEY F X,KRESS D C,et al.Pharmacological strategies for prevention of postoperative atrial fibrillation[J].Expert Rev Clin Pharmacol,2015,8(2):233-250.
[7] 王玉兵,殷跃辉.心房颤动治疗进展[J].中国当代医药,2018,25(16):28-31,35.
[8] MAESEN B,NIJS J,MAESSEN J,et al.Post-operative atrial fibrillation:a maze of mechanisms[J].Europace,2012,14(2):159-174.
[9] VOIGT N,HEIJMAN J,WANG Q,et al.Cellular and molecular mechanisms of atrial arrhythmogenesis in patients with paroxysmal atrial fibrillation[J].Circulation,2014,129(2):145-156.
[10] JACOB K A,NATHOE H M,DIELEMAN J M,et al.Inflammation in new-onset atrial fibrillation after cardiac surgery:a systematic review[J].Eur J Clin Invest,2014,44(4):402-428.
[11] AMAR D,ZHANG H,MIODOWNI K,et al.Competing autonomic mechanisms precede the onset of postoperative atrial fibrillation[J].J Am Coll Cardiol,2003,42(7):1262-1268.
[12] ISHⅡ Y,SCHUESSLER R B,GAYNOR S L,et al.Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation[J].Circulation,2005,111(22):2881-2888.
[13] SCHNABEL R B,SULLIVAN L M,LEVY D,et al.Development of a risk score for atrial fibrillation (Framingham Heart Study):a community-based cohort study[J].Lancet,2009,373(9665):739-745.
[14] BRUINS P,TE VETHUIS H,YAZDANBAKHSH A P,et al.Activation of the complement system during and after cardiopulmonary bypass surgery:postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia[J].Circulation,1997,96(10):3542-3548.
[15] BOOS C J,ANDERSON R A,LIP G Y.Is atrial fibrillation an inflammatory disorder?[J].Eur Heart J,2006,27(2):136-149.
[16] VIOLI F,PASTORI D,PIGNATELLI P,et al.Antioxidants for prevention of atrial fibrillation:a potentially useful future therapeutic approach? A review of the literature and meta-analysis[J].Europace,2014,16(8):1107-1116.
[17] KOTTKAMP H.Human atrial fibrillation substrate:towards a specific fibrotic atrial cardiomyopathy[J].Eur Heart J,2013,34(35):2731-2738.
[18] BURSTEIN B,NATTEL S.Atrial fibrosis:mechanisms and clinical relevance in atrial fibrillation[J].J Am Coll Cardiol,2008,51(8):802-809.
[19] JAHANGIR A,HAMMILL S C.Parasympathetics and atrial fibrillation[J].J Cardiovasc Electrophysiol,2005,16(8):885-887.
[20] KALMAN J M,MUNAWAR M,HOWES L G,et al.Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation[J].Ann Thorac Surg,1995,60(6):1709-1715.
[21] DIMMER C,TAVERNIER R,GJORGOV N,et al.Variations of autonomic tone preceding onset of atrial fibrillation after coronary artery bypass grafting[J].Am J Cardiol,1998,82(1):22-25.
[22] HEIJMAN J,VOIGT N,NATTEL S,et al.Cellular and molecular electrophysiology of atrial fibrillation initiation,maintenance,and progression[J].Circ Res,2014,114(9):1483-1499.
[23] WAN S,IZZAT M B,LEE T W,et al.Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury[J].Ann Thorac Surg,1999,68(1):52-57.
[24] ZAKKAR M,ASCIONE R,JAMES A F,et al.Inflammation,oxidative stress and postoperative atrial fibrillation in cardiac surgery[J].Pharmacol Ther,2015,154:13-20.
[25] YADAVA M,HUGHEY A B,CRAWFORD T C.Postoperative atrial fibrillation:incidence,mechanisms,and clinical correlates[J].Heart Fail Clin,2016,12:299-308.
[26] JANUARY C T,WANN L S,ALPERT J S,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society[J].J Am Coll Cardiol,2014,64:e1-76.
[27] QU C,WANG X W,HUANG C,et al.High mobility group box 1 gene polymorphism is associated with the risk of postoperative atrial fibrillation after coronary artery bypass surgery[J].J Cardiothorac Surg,2015,10:88.
[28] KRAMER P A,CHACKO B,RAVI S,et al.Hemoglobin-associated oxidative stress in the pericardial compartment of postoperative cardiac surgery patients[J].Lab Invest,2015,95:132-41.
[29] MOSTAFA A,EL-HADDAD M A,SHENOY M,et al.Atrial fibrillation post cardiac bypass surgery[J].Avicenna J Med,2012,2(3):65-70.
[30] MITCHELL L B.CCS Atrial Fibrillation Guidelines Committee.Canadian Cardiovascular Society atrial fibrillation guidelines 2010:prevention and treatment of atrial fibrillation following cardiac surgery[J].Can J Cardiol,2011,27:91-97.
[31] CHANDY J,NAKAI T,LEE R J,et al.Increases in P-wave dispersion predict postoperative atrial fibrillation after coronary artery bypass graft surgery[J].Anesth Analg,2004,98:303-310.
[32] VILLAREAL R P,HARIHARAN R,LIU B C,et al.Postoperative atrial fibrillation and mortality after coronary artery bypass surgery[J].J Am Coll Cardiol,2004,43:742-748.
[33] MATHEW J P,FONTES M L,TUDOR IC,et al.A multicenter risk index for atrial fibrillation after cardiac surgery[J].JAMA,2004,291:1720-1729.
[34] CHACKO B K,KRAMER P A,RAVI S,et al.The Bioenergetic Health Index:a new concept in mitochondrial translational research[J].Clin Sci (Lond),2014,127:367-373.
[35] AMAT-SANTOS I J,RODES-CABAU J,URENA M,et al.Incidence,predictive factors,and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation[J].J Am Coll Cardiol,2012,59:178-188.
[36] HALKOS M E,PUSKAS J D.Off-pump coronary surgery:where do we stand in 2010?[J].Curr Opin Cardiol,2010,25:583-588.
[37] ATTARAN S,SHAW M,BOND L,et al.Atrial fibrillation postcardiac surgery:a common but a morbid complication[J].Interact Cardio Vasc Thorac Surg,2011,12:772-777.
[38] SIRCH J,LEDWON M,PUSKI T,et al.Active clearance of chest drainage catheters reduces retained blood[J].J Thorac Cardiovasc Surg,2016,151:832-838.e2.
[39] ZAMAN A G,ALAMGIR F,RICHENS T,et al.The role of signal averaged P wave duration and serum magnesium as a combined predictor of atrial fibrillation after elective coronary artery bypass surgery[J].Heart,1997,77:527-531.
[40] SVAGZDIENE M,SIRVINSKAS E.Changes in serum electrolyte levels and their influence on the incidence of atrial fibrillation after coronary artery bypass grafting surgery[J].Medicina (Kaunas),2006,42:208-214.
[41] de BAAIJ J H,HOENDEROP J G,BINDELS R J.Magnesium in man:implications for health and disease[J].Physiol Rev,2015,95:1-46.
[42] GILLINOV A M,BAGIELLA E,MOSKOWITZ A J,et al.Rate control versus rhythm control for atrial fibrillation after cardiac surgery[J].N Engl J Med,2016,374:1911-1921.
[43] MELBY S J.Might a beta blocker finally provide some relief from postoperative atrial fibrillation?[J].J Thorac Cardiovasc Surg,2015,150:965-966.
[44] TROHMAN R G.Amiodarone prophylaxis reduces major cardiovascular morbidity and length of stay after cardiac surgery:a meta-analysisr[J].Ann Intern Med,2005,143:327-336.

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