结核毁损肺胸膜全肺切除术后并发心律失常的危险因素分析与治疗

Risk factors analysis and treatments associated with cardiacarrhythmia in Pneumonectomy operation for destroyed lung of tuberculosis

目的研究结核毁损肺患者接受单侧胸膜全肺切除术后并发心律失常的情况及危险因素分析,为术前准备及围术期治疗提供指导。方法选择52例结核毁损肺患者接受单侧胸膜全肺切除术患者,术后心律失常32例为观察组,无心律失常20例为对照组,分析导致术后出现心律失常的原因。单因素分析进行掊2检验,采用Logistic回归进行多因素分析。比较心律失常组与对照组在住院时间、住院费用方面的差异。结果 32例术后心律失常组室上性心动过速,频发早搏,房颤发生在术后1周内。单因素分析:患者的年龄、手术前FEV1%下降、手术中出血量、手术后低氧血症是胸膜全肺切除术后并发心律失常的相关因素,术中出血量和术后低氧血症为危险因素。心律失常组住院时间延长,住院费用增加。结论结核性毁损肺接受胸膜全肺切除术后应重点治疗手术后渗血,加强术后低氧血症的监测与治疗,维护手术后患者循环及氧合的稳定,提高围手术期患者的救治成功率。

Objective To analyze risk factors of cardiacarrhythmia in patients who accepted the pneumonectomy operation for destroyed lung of tuberculosis,in order to get a guide to treat these patients from preoperation to postoperation.Methods Fifty-two patients who suffered from the destroyed lung of tuberculosis from June 2008 to December 2009 were selected,all of them got the operation.The patients with cardiacarrhythmia were considered as treatment group,and the patients with no cardiacarrhythmia were as control group.The reasons which resulted in cardiacarrhythmia were analyzed.The single factor was tested by x2,and the logistic regression was used to analysis the risk factors.The time in hospital and the expenditure were compared between two groups.Results Cardiacarrhythmia occurred in 32 patients in the first week after operation：supraventricular tachycardia,premature,and auricular fibrillation.Ages,the preoperation FEV1%,the volume of bleeding in operation,and the oxygen saturation index were associated with the cardiacarrhythmia for postoperation.The risk factors were the volume of bleeding in operation and the low oxygen saturation index.The patients with cardiacarrhythmia would stay in ICU and in hospital for more days,so they paid more money.Conclusions We should treat the bleeding during the operation,correct the apnea,and monitor the oxygen saturation index in patients with cardiacarrhythmia.We can get a good result from treating cardiacarrhythmia and smoothing the circulation.