急诊非心胸外科手术后房颤发生率及危险因素是什么？

房颤会增加患者术后并发症的发生率、住院时间及死亡率，虽然术后房颤常发生在心胸外科手术后，但其他手术，特别是急诊手术术后房颤的发生率如何呢？那些危险因素可能增加术后房颤的发生率呢？这些问题的答案在这篇发表在European Journal of Anaesthesiology杂志上的系统综述复习已有相关文献，对此展开了详细的探讨。

摘要译文

急诊非心胸外科手术后心房颤动的系统评价

背景：术后房颤（POAF）常发生在心胸外科手术后，与较高的死亡率和较长的住院时间有关。在非心胸外科手术和急诊手术后房颤发生情况的研究较少。

目的：探讨急诊非心胸外科手术后心房颤动的发生率、相关危险因素及死亡率。

设计：我们根据系统性审查和荟萃分析指南的首选报告项目进行了系统性审查。观察研究和随机对照试验采用Downs-and-Black检查表和Cochrane干预系统回顾手册评估偏倚风险。

资料来源：2019年8月对PubMed、EMBASE和Scopus进行了系统的文献检索。没有出版日期或来源限制。

合格标准：观察和随机对照试验包括在成人患者急诊非心胸外科手术后发生的POAF的数据。

结果：我们确定了15项符合纳入标准的研究，包括骨科、腹部、血管、神经和其他非心胸外科手术。急诊非心胸外科手术后POAF的发生率在1.5%到12.2%之间，这取决于手术类型和心脏监护的强度。调查危险因素和相关死亡率的研究发现急诊手术和年龄增长与POAF的风险相关。此外，POAF通常与长期和短期死亡率的增加有关。

结论：在本研究中，房颤发生率较高，尤其是急诊骨科、血管外科和神经外科手术后。急诊手术和年龄是房颤发生的独立危险因素。POAF似乎与术后并发症和死亡率的高风险有关，但仍需进一步的长期随访研究。

试验注册号：CRD42019112090。

原文摘要

Postoperative Atrial Fibrillation Following Emergency Noncardiothoracic Surgery: A Systematic Review

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 identified 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.

Trial registration: CRD42019112090.