Objective:To analyze the incidence and risk factors of postoperative new-onset atrial fibrillation(POAF) after lobectomy.Methods:A monocentric ambispective cohort study was conducted. The retrospective cohort included 1 902 patients who underwent lobectomy in our hospital between January 2017 and December 2019. The prospective cohort included 692 patients who underwent lobectomy in our hospital between August 2020 and July 2021. A total of 2 594 patients were enrolled in this study. The median age of enrolled patients was 61 years(interquartile range, 54-67 years), and the cohort consisted of 1 384(51.97%) females and 1 246(48.03%) males. Baseline and perioperative clinical data of enrolled patients were collected. Univariate and multivariate logistic regression analyses were performed to identify the risk factors related to POAF. Results:There was no patient died in hospital after surgery. A total of 111 cases of POAF were followed up during the postoperative hospital period, and the incidence of POAF was 4.28%. Multivariate regression analysis found that the elderly patients(aged 60 and above)( OR=1.58, 95% CI: 1.01-2.47, P=0.044), history of percutaneous coronary intervention( OR=2.50, 95% CI: 1.04-6.03, P=0.041), history of arrhythmia excluding atrial fibrillation/flutter( OR=3.96, 95% CI: 1.95-8.00, P<0.001), left upper lobectomy( OR=1.73, 95% CI: 1.11-2.68, P=0.015), low preoperative albumin level( OR=1.07, 95% CI: 1.00-1.14, P=0.048) and large cell neuroendocrine carcinoma( OR=4.70, 95% CI: 1.38-15.98, P=0.013) were independent risk factors for POAF after lobectomy. Conclusion:The incidence of POAF after lobectomy is 4.28% in this study. Elderly patients(aged 60 and above), history of percutaneous coronary intervention, history of arrhythmia excluding atrial fibrillation/flutter, left upper lobectomy, low preoperative albumin level, and large cell neuroendocrine carcinoma are the independent risk factors related to POAF after lobectomy.

Objective To share our experience of percutaneous or transthoracic closure of atrial septal defect (ASD) and ventricular septal defect (VSD) supported by echocardiography guidance. Methods From December 2010 to September 2019, 54 patients of congenital heart disease (30 cases of isolated atrial septal defect, 24 cases of ventricular septal defect) were treated with surgical operation by occluder under guidance of echocardiography closed without cardiopulmonary bypass. Fourteen cases of ASD were performed device closure through a small right sternal margin thoracotomy incision at the forth intercostal space, 16 cases of ASD underwent percutaneous occlusion surgery, and 24 cases of VSD were closed through small incision under the xiphoid process. Results The operations were successful in the 24 cases of VSD. One of the cases with minimally incision ASD occlusion was displaced 7 hours after operation, the occluder was taken out and ASD was repaired under cardiopulmonary bypass in emergency. There were 13 cases of successful occlusion and 3 cases of failure in percutaneous ASD closure patients. Among three cases, 2 cases underwent ASD closed through transthoracic closure and 1 case underwent open surgery under cardiopulmonary bypass successfully. The 46 cases were followed up for 3-103 months, with an average of (21.3±16.2)months. No occluder displacement, shedding, significant residual shunt were observed. Conclusions Echocardiography-guided percutaneous atrial septal defect and ventricular septal defect is safe and effective without radiation and CPB. Percutaneous closure of atrial septal defect is suitable for children over 3 years. Atrial septal defect and ventricular septal defect occlusion through small thoracic incision is feasible and easy to operate in other healthcare institutions.

目的:调查解剖性肺段切除术后心房颤动(POAF)发病率并分析相关危险因素.方法:采用单中心双向队列研究方法,回顾队列纳入了 2017年1月至2019年12月期间,于我院行解剖性肺段切除患者387例,前瞻性队列纳入了 2020年8月至2021年7月期间,于我院行解剖性肺段切除患者439例,共纳入826例.纳入患者中位年龄58(51,65)岁,女性患者518例(62.7％),男性患者308例(37.3％).收集纳入患者的基线资料和围术期临床资料.对纳入变量先后进行单因素和多因素Logistic回归分析,以探寻POAF相关危险因素.结果:术后在院期间共随访发现15例POAF事件,POAF发病率为1.8％.无患者发生术后院内死亡.多因素回归分析发现,男性(OR=4.15,95％CI:1.26～13.63,P=0.019)、术前白蛋白水平偏低(OR=1.25,95％CI:1.04～1.52,P=0.017)、既往心律失常病史(除心房颤动、心房扑动外)(OR=5.91,95％CI:1.10～31.61,P=0.038)是解剖性肺段切除术后发生心房颤动的危险因素.结论:解剖性肺段切除术后心房颤动发生率1.8％,男性、术前白蛋白水平偏低、除心房颤动/心房扑动外其他心律失常病史是POAF相关危险因素.

目的:分析影响左侧瓣膜术后三尖瓣大量反流行再次三尖瓣手术早期预后的影响因素.方法:回顾性分析2017年10月至2021年2月,北京大学国际医院收治左侧瓣膜术后三尖瓣大量反流拟行再次三尖瓣手术患者,其中利尿剂应用呋塞米超过40 mg/d(或等效剂量)者44例,根据其一周体质量调整是否超过3 kg分为两组,通过术后随访对影响早期预后的影响因素进行分析.结果:入选患者男性17例(38.6％),平均年龄(56±13)岁,对于体质量调整≥3 kg以及<3 kg组,基线资料基本一致,随访患者44例(100％),随访过程终点事件如下:死亡6例(13.6％),因心功能不全等入院治疗或转入监护室者2例(4.5％),其他情况如复查彩超三尖瓣重度反流、双下肢水肿并无法减停利尿药等4例(9.1％),两组发生率[(11(37.9％)vs.1(6.7％),P=0.035]显著增加.结论:在左侧瓣膜术后三尖瓣大量反流拟行再次三尖瓣手术的患者中,部分患者需要服用利尿剂超过40 mg/日呋塞米(或等效剂量)用于控制症状,利尿剂反应性和手术预后相关,体质量降低≥3 kg组,早期事件发生率显著增加.