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目的探讨P波离散度(Pd)和动态心电图(AECG)预测胸部肿瘤术后心房颤动(AF)的临床价值。方法回顾分析中国医学科学院肿瘤医院ICU2007年1月至2009年12月间术前接受AECG检查的272例胸部肿瘤手术患者的资料,对可能的影响发生房颤的因素进行单因素和多因素Logistic分析。结果除外122例患者,可分析病例150例。AF发生率25.3%(38/150)。多因素分析显示Pd(OR=1.031,95%CI:1.000-1.064,p=0.048)和AECG(OR=8.694,95%CI:3.083-25.514,p<0.001)是AF发生的独立危险因素。Pd预测AF发生的敏感性86.8%,特异性39.3%。术前AECG预测术后AF发生的敏感性44.7%,特异性91.1%。联合应用AECG和P波离散度预测AF发生的敏感性89.5%,特异性39.3%。结论 P波离散度预测胸部肿瘤术后AF发生的敏感性高,术前AECG检查预测的特异性好。
Objective To investigate the clinical value of P wave dispersion (Pd) and ambulatory electrocardiogram (AECG) in predicting postoperative atrial fibrillation (AF) in thoracic tumors. Methods A retrospective analysis was conducted on the data of 272 patients with thoracic tumor who underwent AECG before operation from January 2007 to December 2009 in Cancer Hospital of Chinese Academy of Medical Sciences. Univariate and multivariate Logistic analyzes were performed on the possible factors that influence the occurrence of atrial fibrillation . Results except for 122 patients, 150 cases can be analyzed. The incidence of AF was 25.3% (38/150). Multivariate analysis showed that Pd (OR = 1.031, 95% CI: 1.000-1.064, p = 0.048) and AECG (OR = 8.694, 95% CI: 3.083-25.514, p <0.001) were independent risk factors for AF. Pd predicts the occurrence of AF sensitivity 86.8%, specificity 39.3%. Preoperative AECG prediction of postoperative AF occurred in 44.7% sensitivity and specificity of 91.1%. The combined application of AECG and P wave dispersion predicts the sensitivity and the specificity of AF to 89.5% and 39.3% respectively. Conclusions P wave dispersion predicts the high sensitivity of postoperative AF in chest tumor and the specificity of preoperative AECG examination is good.