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本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见 Patients at High Risk for Obstructive Sleep Apnea Are at Increased Risk for Atrial Fibrillation After Cardiac Surgery: A Cohort Analysis 背景与目的 阻塞性睡眠呼吸暂停（OSA）综合征患者在睡眠期间经历间歇性缺氧、高碳酸血症和交感神经激活，这增加了阵发性心房颤动和其他心律失常的发生风险。OSA患者心脏手术后心房颤动的发情况尚不清楚。本研究通过STOP-BANG（打鼾，白天疲倦，睡眠中停止呼吸，高血压，体重指数超过35kg/m2，年龄超过50岁，颈围超过40cm，男性）问卷评估方式评价患者OSA发生风险是否增加。因为术后心房颤动和OSA都需要医疗措施支持，所以本研究也观察了OSA发生风险增加的患者术后机械通气时间是否更长，以及重症监护病房(ICU)的住院时间。 方 法 经伦理审查委员会批准，本回顾性观察研究评估了2014年至2015年间接受体外循环的心脏手术的成人患者，并利用STOP-BANG问卷对OSA风险进行术前评估。心房颤动史患者不在研究范围。采用多变量logistic回归模型比较STOP-BANG评分与术后房颤的关系。其次，我们利用多元线性回归法评估STOP-BANG评分与再次插管时间的相关性， 继续使用Cox比例风险回归分析其与I患者在ICU住院时间的关系。本试验描述了需要气管再插管机械通气的患者所占百分比。 结 果 在4228例心脏手术患者中，1593例符合标准。STOP-BANG评分增高与术后心房颤动发生率增加相关（STOPBANG评分每增加一分，OR=1.16，95%CI=1.09–1.23；P<0.001）。STOP-BANG评分与ICU住院时间或再插管时间无相关性：（STOP-BANG评分每增加一分，HR=0.99，97.5%CI=0.96-1.03]；P=.99），（97.5%CI=1.00-1.04；P=.03）；显著性标准Bonfer＜0.025。百分之一的患者需要再次插管。 结 论 结论：STOP-BANG评分高、OSA的发生风险增加与心脏手术患者术后房颤的高发生率相关，但不会延长机械通气持续时间或ICU住院时间。 原始文献摘要 Karimi N, Kelava M, Kothari P, et al. Patients at High Risk for Obstructive Sleep Apnea Are at Increased Risk for Atrial Fibrillation After Cardiac Surgery: A Cohort Analysis.[J]. Anesthesia & Analgesia, 2018:1. [Abstract] Backgrand: Patients with obstructive sleep apnea (OSA) experience intermittent hypoxia, hypercarbia, and sympathetic activation during sleep, which increases risk for paroxysmal atrial fibrillation and other cardiac arrhythmias. Whether patients with OSA experience increased episodes of atrial fibrillation after cardiac surgery is unclear. We examined whether patients at increased risk for OSA, assessed by the STOP-BANG (snoring, tired during the day, observed stop breathing during sleep, high blood pressure, body mass index more than 35 kg/m2, age more than 50 years, neck circumference more than 40 cm, and male gender) questionnaire, had a higher incidence of new-onset postoperative atrial fibrillation after cardiac surgery. Because both postoperative atrial fibrillation and OSA increase resource utilization, we secondarily examined whether patients at increased OSA risk had longer duration of postoperative mechanical ventilation and intensive care unit (ICU) length of stay Methed: With institutional review board approval, this retrospective observational study evaluated adult patients who underwent elective cardiac surgery requiring cardiopulmonary bypass between 2014 and 2015 with preoperative assessment of OSA risk using the STOP-BANG questionnaire.Patients with a history of atrial fibrillation were excluded. The association between the STOP-BANG score and postoperative atrial fibrillation was examined using a multivariable logistic regression model. Secondarily, we estimated the association between the STOP-BANG score and duration of initial intubation using multivariable linear regression and ICU length of stay using Cox proportional hazards regression. We also descriptively summarized the percentage of patients requiring tracheal reintubation for mechanical ventilation Results：Of 4228 cardiac surgery patients, 1593 met inclusion and exclusion criteria. An increased STOP-BANG score was associated with higher odds of postoperative atrial fibrillation (odds ratio [95% confidence interval {CI}], 1.16 [1.09–1.23] per-point increase in the STOPBANG score; P < .001). The STOP- BANG score was not associated with ICU length of stay (estimated hazard ratio [97.5% CI], 0.99 [0.96 1.03] per-point increase in the STOP-BANG score; P= .99) or duration of initial intubation (ratio of geometric means [97.5% CI], 1.01 [1.00–1.04];P = .03; significance criterion [Bonferroni correction] < 0.025). One percent of patients required reintubation. Conclusion: Increasing risk for OSA, assessed by STOP-BANG, was associated with higher odds of postoperative atrial fibrillation, but not prolonged duration of mechanical ventilation or ICU length of stay 麻醉学文献进展分享 贵州医科大学高鸿教授课题组 编辑：符校魁 审校：余晓旭 |
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