| Objective:Atrial Fibrillation (AF) is the most commonly complications following cardiac surgery. The occurrence of AF is about15%-40%in patients undergoing coronary artery bypass graft surgery(CABG). In this study, AF occurred in less than72h after operation, and are mostly self-limiting, but still increased the incidence of shock, stroke, renal dysfunction, death and other complications, making the length of hospital stay and the more costs. Recently, a little of studies have shown that plasma N-terminal brain natriuretic peptide (NT-pro-BNP) can be used as a predictor of postoperative atrial fibrillation(POAF). The aim of this study to evaluate the clinical utility of plasma NT-pro-BNP as an independent predictor of AF in patients undergoing CABG.Methods:This study included115consecutive patients(male70cases,45cases of female, age43-79years old, weight50-81kg) in sinus rhythm (SR) undergoing CABG between July1,2011and December31,2011. All the selected patients were asked in detail about medical history. The following is exclusion criteria, previous history of AF, oral antiarrhythmic drugs, NYHA class IV, suffering from acute coronary syndrome within60days, severe dysfunction of liver, kidney and blood system, CABG with other cardiac surgery, emergency surgery. The patients were grouped into SR and AF groups depending on their respective postoperative rhythm.ECG and echocardiography as a routine check for all patients.Blood sample of routine chemistry were drawed in all patients before surgery. All the patients had the coronary artery angiography before surgery. And the blood sample of NT-pro-BNP drawed in all patients preoperative24h and postoperative1h, then separated at room temperature and frozened at-20℃.All patients were placed on continuous cardiac monitoring until postoperative day5. And12-lead ECG was obtained on the day from postoperative day5to10. Any clinical suspicion of arrhythmia was followed by12-lead ECG. If the POAF continues5min,the patient will be included in the AF group.By using the SPSS12.0statistical software package to analysis all datas. Results with a value of P<0.05were considered statistically significant.Results:A total of36patients occurred POAF. The occurrence rate was31.3%.5postoperative days were the focus time and the average time is2.7±2.2days. Group of AF patients with higher age (65±vs58±9, P<0.001), larger LAD (44±7vs43±7, P=0.032), higher EuroSCORE (3.8±2.5vs2.6±2.2, P=0.005), lower oral beta-blocker ratio (66.7%vs84.8%, P=0.033). The performance of age and EuroSCORE is especially outstanding.Partly perioperative data between two groups also had statistically significant. The group of AF patients with a longer time of staying in ICU (4+0.7vs3.2+0.5, P<0.001). The incidence of POAF of CABG group higher than OPCAB group (42%, vs22%, P=0.021). SR group had a longer cardiopulmonary bypass time than AF group(103+26vs89+24, P=0.047),which happened in CABG group. The variables of age, LAD, EuroSCORE, oral beta-blocker, CPB, NT-pro-BNPa and NT-pro-BNPb were scrutinized use the multiple linear regression analysis. We found that, except age, the NT-pro-BNPa was an independent predictor of POAF.Conclusion:1. The indictors of older, larger LAD, higher EuroSCORE was the risk factors for AF after coronary artery bypass grafting.2. More using beta-blocker, choosing OPCAB and shortening the time of CPB could reduce the occurrence of AF. 3. Except age, the NT-pro-BNPa was an independent predictor of AF. after coronary artery bypass grafting... |
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