小儿先天性心脏病直视手术后心律失常的影响因素及处理

Concerned factors and managements of postoperative arrhythmias after open heart surgery in children with congenital heart malformations

目的 探讨先天性心脏病直视手术后心律失常的影响因素及预防、处理措施。方法 对 2 87例心脏直视手术患儿术后心律失常的发生因素进行分析。结果 6 7例患儿术后出现心律失常 79例次 ,发生率为 2 3.3%。包括各类早搏、室上性心动过速、心房颤动、 度或 度房室传导阻滞。复杂心血管畸形术后心律失常发生率较高。低年龄、心功能差、体外循环和阻断主动脉时间长、术后低血钾和低心排出量是术后心律失常的影响因素 ,P<0 .0 1。结论 心脏直视手术后心律失常的发生与手术复杂程度、患者年龄、心功能、术中体外循环和阻断主动脉时间、术后低血钾和低心排出量有密切关系。术前设法改善心功能 ,术中尽量缩短体外循环和阻断主动脉时间 ,术后及时纠正低血钾和低心排出量 ,是预防术后心律失常发生的重要措施。

Objective The aim of this study was to investigate the concerned factors and the measures of prevention and management for postoperative arrhythmias after open heart surgery in patients with congenital heart malformations. Methods The induced factors of postoperative arrhythmias were investigated in 287 patients who had undergone open heart surgery. Results 79 postoperative arrhythmias occurred in 67 patients (23.3%). Arrhythmias consisted of premature complexes, supraventricular tachycardia, atrial fibrillation and atrioventricular block Ⅱto Ⅲ. The proportion of postoperative arrhythmias was higher in patients with complex heart malformations than those in patients with simple one. The concerned factors for postoperative arrhythmias were low patient age, poor cardiac function, longer extracorporal circulation time and aortic clamping duration, postoperative hypokalemia and low cardiac output. All differences were highly significant (P<0.01). Conclusion Arrhythmic occurrence was closely related with the surgical complexity, patient age, cardiac function, extracorporal circulation time and aortic clamping duration, postoperative hypokalemia and low cardiac output. The measures such as improving cardiac function, shortening extracorporal circulation time and aortic clamping duration, supplying potassium and managing low cardiac output are important in prophylaxis of postoperative arrhythmias.