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《Chinese Journal of Critical Care Medicine》 2019-02
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Effect of the duration of new-onset atrial fibrillation on the clinical outcomes of the patients undergoing ICU non-cardiac surgery

Wu Chun-fang;Wang Shao-ai;Lin Yong-jun;Department of Geriatrics,Quanzhou First Hospital of Fujian Medical University;  
Objective To evaluate the effect of the duration of new-onset atrial fibrillation(NeOAF) on the clinical outcome of the patients with ICU non-cardiac surgery. Methods The clinical data of 282 NeOAF patients undergoing non-cardiac surgery in ICU was analyzed retrospectively, including the patient's clinical features, hemodynamic parameters, interventions, and clinical outcomes. The patients were subjected to clinical dynamic electrocardiogram monitoring.According to whether the sinus rhythm(SR) is restored after 6 h of atrial fibrillation, the patients were divided into the AF groups and the SR groups. The clinical data of two groups of patients were compared to evaluate the effect of AF duration on the clinical outcome of patients. Multivariate Logistic regression analysis was used to evaluate the association between NeOAF duration and the patient death. The NeOAF duration to onset in patients with NeOAF was calculated to evaluate the relationship between the NeOAF duration of NeOAF and the incidence of in-hospital mortality and in-hospital stroke. Results Of the282 patients enrolled, 97(34. 4%) had a NeOAF duration of more than 6 hours, and 185(65. 6%) of the patients had a NeOAF duration of less than 6 hours and rapidly restored SR. In-hospital mortality was significantly higher in the AF group than in the SR group [36.1%(35/97) vs. 20.0%(37/185),χ~2 =8.657, P= 0.003]. Multivariate Logistic regression analysis showed that the duration of NeOAF over 6 h was significantly associated with an increased risk of in-hospital mortality(OR =3.153, 95%CI 1.291 ~ 7. 678, P =0. 013). The Cochran-Armitage trend test showed that patients with longer NeOAF duration had higher in-hospital mortality(P = 0. 042) and ischemic stroke(P = 0. 040).Conclusion Sustained NeOAF can worsen the outcome of patients with non-cardiac surgery in ICU,and longer durations of NeOAF are associated with higher in-hospital mortality and incidence of in-hospital stroke. Clinicians should take active treatment measures according to the clinical characteristics of NeOAF patients to improve their outcome.
【CateGory Index】: R541.75
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