急诊非心胸外科手术后房颤：系统回顾
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急诊非心胸外科手术后房颤：系统回顾
翻译：牛振瑛 编辑：冯玉蓉 审校：曹莹
背景：术后房颤(POAF)常发生于心胸外科手术后，并与较高的死亡率和较长的住院时间相关。非心胸外科手术和急诊手术后POAF发生情况的研究较少。
目的：对急诊非心胸外科手术后房颤的发生情况及相关危险因素和死亡率进行系统回顾研究。
设计：我们根据系统综述和Meta分析指南的首选报告项目进行了系统评价。观察性研究和随机对照试验的偏倚风险评估采用Downs和Black检查表，干预措施采用Cochrane手册进行系统评价。
数据来源：检索PubMed、EMBASE和Scopus数据库从建库至2019年8月已经发表的文章。
纳入标准：成年患者急诊非心胸外科手术POAF发生情况的观察性和随机对照试验研究。
结果：共纳入15项符合条件的研究，包括骨科、腹部、血管、神经和其他非心胸外科手术。根据手术类型和心脏监测程度的不同，急诊非心胸外科手术后POAF的发生率为1.5%~12.2%。对危险因素和相关死亡率的研究发现，急诊手术和年龄增加与POAF的风险有关。此外，POAF通常与长期和短期死亡率的增加有关。
结论：本研究发现，房颤发生频繁，尤其是在骨科、血管和神经外科急诊手术后发生率较高。急诊手术和年龄是房颤发生的独立危险因素。POAF可能与术后并发症和死亡率高风险有关，但仍需进一步长期随访研究。
原始文献来源；Bjerrum E, Wahlstroem KL, Gögenur I,et al. Postoperative atrial fibrillation following emergency noncardiothoracic surgery：A systematic review.[J].Eur J Anaesthesiol. 2020 Aug; 37(8) :671-679.doi:10.1097/EJA.0000000000001265.
Postoperative atrial fibrillation following emergency noncardiothoracic surgery：A systematic review
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) occurs frequently following cardiothoracic surgery and is associated with a higher mortality and a longer hospital stay. The condition is less studied following noncardiothoracic surgery as well as emergency surgery.
OBJECTIVE The aim of this systematic review was to investigate the occurrence of atrial fibrillation following emergency noncardiothoracic surgery and associated risk factors and mortality.
DESIGN We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Observational studies and randomised controlled trials were assessed for risk of bias using the Downs and Black checklist and Cochrane Handbook for Systematic reviews of intervention.
DATA SOURCES A systematic literature search of PubMed, EMBASE and Scopus was carried out in August 2019. No publication date- or source restrictions were imposed.
ELIGIBILITY CRITERIA Observational and randomised controlled trials were included if data on POAF occurring after an emergency, noncardiothoracic, surgical intervention on adult patients could be extracted.
RESULTS We identifified 15 studies eligible for inclusion covering orthopaedic-, abdominal-, vascular-, neuro- and miscellaneous noncardiothoracic surgery. The occurrence of POAF after emergency noncardiothoracic surgery ranged from 1.5 to 12.2% depending on type of surgery and intensity of cardiac monitoring. Studies that investigated risk factors and associated mortality found emergency surgery and increasing age to be associated with risk of POAF. Moreover, POAF was generally associated with an increase in long-term and short-term mortality.
CONCLUSION In this study, atrial fibrillation occurred frequently, especially following emergency orthopaedic, vascular and neurosurgery. Emergency surgery and age were independent risk factors for developing atrial fibrillation. POAF seems to be related to a higher risk of postoperative complications and mortality, though further studies with long-term follow-up are needed.
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