肝移植术后房颤与房扑可作为患者早期和晚期发病率和死亡率的重要预测因素
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Postoperative Atrial Fibrillation and Flutter in Liver Transplantation: An Important Predictor of Early and Late Morbidity and Mortality
背景与目的
术后心房颤动/扑动(POAF)是围手术期最常见的心律失常，肝移植(LT)术后尤为严重。本研究是一项单中心回顾性分析，以确定其在肝移植后的发病率，找出其危险因素，评估其对临床结果的影响，并总结其管理策略。
方 法
回顾了2010年至2018年接受肝移植治疗的所有患者记录。提取的数据包括肝移植前的人口统计学和心脏评估，住院期间肝移植后的心脏事件，早期和晚期并发症，以及生存率。
结 果
在1011例患者中，肝移植后术后心房颤动/扑动(POAF)的发生率为10.1%。采用二元Logistic回归，房颤发生前的肝移植史对术后心房颤动/扑动(POAF)F的预测作用最强(优势比(OR)6.7，置信区间(CI)2.0-22.6，p<0.001)，其次是冠心病史(优势比2.5，CI 1.1-5.8，p=0.03)。心脏压力测试异常和心导管相关的冠心病也有较高的危险性。肝移植后POAF发病的中位时间为3天，72%的患者在48小时内消失。POAF患者住院时间更长，住院期间死亡，90天和1年死亡率更高。POAF是肝移植后死亡率的独立危险因素(OR 2.0，CI1.3~3.0，P<0.01).对73%POAF患者给予胺碘酮，无血清丙氨酸氨基转移酶升高迹象。
结 论
10.1%的肝移植后患者出现POAF，在大多数受影响的患者中出现早期发病和快速缓解。然而，POAF患者具有显著的发病率和死亡率，这表明POAF是早期和晚期术后结局较差的重要标志。
原始文献摘要
Rayan Jo Rachwan, Issa Kutkut, Taylor J. Hathaway, Lava R. Timsina, Chandrashekhar A. Kubal, Marco A. Lacerda, Marwan S. Ghabril, Patrick D. Bourdillon, Richard S. Mangus，Postoperative Atrial Fibrillation and Flutter in Liver Transplantation: An Important Predictor of Early and Late Morbidity and Mortality，Liver Transpl. 2019 Aug 27. doi: 10.1002/lt.25631
Background Postoperative atrial fibrillation/flutter (POAF) is the most common perioperative arrhythmia and may be particularly problematic after liver transplant (LT). This study is a single-center, retrospective analysis of POAF to determine its incidence following LT, identify risk factors, assess its impact on clinical outcomes, and summarize management strategies.
Methods The records of all patients who underwent LT between 2010 and 2018 were reviewed. Extracted data included pre-LT demographics and cardiac evaluation, inhospital post-LT cardiac events, early and late complications, and survival.
Results Among 1011 patients, the incidence of post-LT POAF was 10.1%. Using binary logistic regression, pre-LT history of atrial fibrillation was the strongest predictor of POAF (Odds Ratio (OR) 6.7, Confidence Interval (CI) 2.0-22.6, p<0.001), followed by history of coronary artery disease (CAD) (OR 2.5, CI 1.1-5.8, p=0.03). Cardiac stress testing abnormality and CAD on cardiac catheterization were also associated with higher risk. Median time to POAF onset after LT was 3 days, with 72% resolving within 48 hours. POAF patients had greater hospital length of stay, death during the LT admission, and 90-day and 1-year mortality. POAF was an independent risk factor for post-LT mortality (OR 2.0, CI 1.3-3.0, p<0.01). Amiodarone was administered to 73% of POAF patients with no evidence of increased serum alanine aminotransferase levels.
Conclusion POAF occurred in 10.1% of post-LT patients, with early onset and rapid resolution in most affected patients. POAF patients, however, had significant morbidity and mortality, suggesting that POAF is an important marker for worse early and late post-LT outcomes.
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贵州医科大学高鸿教授课题组
翻译：任文鑫 编辑：何幼芹 审校：王贵龙