高龄肺癌患者围术期心律失常的相关因素及对策

The Research of Cardiac Arrythmia Occurring in the Postoperative Period of Lung Cancer in the elderly

目的探讨高龄肺癌患者围术期心律失常的原因和治疗对策。方法回顾性分析我院1999年1月至2003年12月手术治疗高龄肺癌患者(≥70岁)363例,术后全部于ICU室进行持续监护至少3天,记录术后发生心律失常者234例。结果高龄肺癌患者术后心律失常发生率64.5%(234/363)明显高于同期非高龄(22～69岁)肺癌患者34.6%(325/938)(P<0.05);术前心电图异常者术后心律失常发生率73.8%(177/240)明显高于术前心电图正常者46.3%(57/123)(P<0.05);全肺切除术后心律失常发生率89.6%(60/67)明显高于肺叶切除、肺楔形切除和剖胸探查者58.8%(174/296)(P<0.05);术前有重度吸烟史者术后心律失常发生率77.8%(168/216)明显高于无重度吸烟史者44.9%(66/147)(P<0.05);术前有心血管病史者术后心律失常的发生率71.2%(203/285)明显高于无心血管病史者39.7%(31/78)(P<0.05)。剖左胸与剖右胸术后心律失常的发生率分别为62.9%(112/178)和65.9%(122/185),两组间差别无显著性(P>0.05)。结论高龄、术前心电图异常及术后刀口疼痛、低血容量和肺部并发症是诱发心律失常的主要因素。术前积极改善心肺功能,严格掌握手术适应症,术后吸氧及加强护理预防肺部炎症等是防治肺癌术后发生心律失常的基本措施。

Objective To analyze the cardiac arrythmia occurring in the postoperative period of lung cancer in the elderly and to investigate the factors of its occurrence and the measures of prevention and treatment. Methods From 1999.1 to 2003.12, There are 363 cases of lung cancer in the elderly operation done and 234 cases of cardiac artythmia among them observed in the postoperative period. After operating, all patients had been received observation in the ICU at least three days. Results The rates of occurrence of postoperative cardiac arrythmia correlated with age, preoperative abnormal electric cardiacgraphy, operative ways, preoperative smoking, and preoperative cardiovascular diseases （p〈0.05）.Conclusion Age, preoperative abnormal electric cardiacgraphy and postoperative complications are factors related to the occurrence of cardiac arrythmia. Therefore, preoperative actively improving the functions of heart and lung, strict indication of operation, postoperative oxygen inhalation and intensive nursing to prevent and treat lung complications are fundamental measures to control the occurrence of postoperative cardiac arrythmia