肿瘤外科ICU室上性心律失常的发生率及危险因素分析

Incidence and risk factors of supraventricular arrhythmias in postoperative cancer patients in intensive care unit

目的探讨肿瘤外科ICU室上性心律失常（SVAs）的发生率及危险因素。方法回顾分析我院ICU 2008年11月至2009年10月间收治570例患者的临床资料，对SVAs可能的影响因素进行单因素和多因素Logistic分析。结果13例有心房颤动病史的患者被除外，入选557例。SVAs发生率为12．93％（72／557）。多因素分析显示年龄（OR=1．066，95％CI：1．034～1．099，P〈0．001）、冠心病病史（OR=2．644，95％CI：1．459—4．790，P〈0．05）、转入时确诊为脓毒症（OR=2．374，95％CI：1．098～5．135，P〈0．05）和胸部外科手术操作（OR=2．322，95％CI：1．061～5．084，P〈0．05）是SVAs发生的独立危险因素。SVAs患者与非SVAs组住ICU时间[2（1—77）、3（1～40）d，Z=-3．505，P〈0．001]和APACHE Ⅱ评分[9（0～37）、11（3～38）分，Z=-3．332，P=0．001]，差异有统计学意义。SVAs组死亡9例（12．5％），非SVAs组死亡19例（3．9％），病死率差异有统计学意义（X^2=9．673，P=0．002）。结论肿瘤外科ICU患者术后SVAs的发生率较高，年龄、冠心病病史、转入ICU时确诊有脓毒症和胸部外科手术操作是术后SVAs发生的独立危险因素。SVAs增加患者住ICU时间，是反映患者病情严重性的一种标志。

Objective To evaluate the incidence and to investigate risk factors of supraventricular arrhythmia （SVAs） in postoperative cancer patients in intensive care unit （ ICU ）. Methods Data of 570 patients consecutively admitted to oncologic surgical ICU of Cancer Hospital of Chinese Academy of Medical Sciences from Nov. 2008 to Oct. 2009 were retrospectively collected. Univariate and multivariate logistic analysis were conducted for potential factors that influenced SAVs. Results Thirteen patients with a history of atrial fibrillation （AF） were excluded and 557 patients were eligible for the study. SVAs occurred in 72 patients （ 12. 93% ）. Multivariate analysis showed four independent predictors of SVAs including age （ OR = 1. 066,95% CI： 1.034-1.099,P〈0.001）,a history of coronary heart diseases （OR =2.644,95% CI： 1.459 -4.790, P 〈 0. 05 ）, sepsis （ OR = 2. 374,95% CI： 1. 098 - 5. 135, P 〈 0. 05 ） and intra-thoraeic procedure （ OR = 2. 322,95% CI： 1. 061 -5. 084 ,P 〈0. 05） . ICU length of stay,severity （APACHE Ⅱ scores in SVAs patients） were significantly greater in patients who were not affected by SVAs （ ICU stay ： [ 2 （ 1 - 77 ） ] vs [ 3 （ 1 - 40 ） ] days,P〈0.001;APACHE Ⅱ score： [9（0 -37）] vs [11（3 -38）],P=0.001）.Nine cases died in SVAs patients （12. 5% ） and 19 died in the non-SVAs patients （3. 9% ）, with significant difference between the two groups（ X^2 = 9. 673,P = 0. 002）. Conclusion In oncologic surgical ICU, the incidence of SVAs is high. Age, history of coronary heart diseases, sepsis and intra-thoracic procedure were independent rsik factors of SVAs. SVAs prolong ICU length of stay. SVAs is a marker of critical illness severity.