普胸术后快速性心律失常危险因素分析及预警系统的建立

Analysis of risk factor and establishment of scoring system for predicting tachyarrhythmia after thoracic surgery

目的 :分析普胸术后快速性心律失常发生的危险因素,初步建立预测心律失常发生的预警系统。方法:对412例普胸外科手术患者的围术期临床资料进行单因素和多因素分析,确定危险因素,建立预警评分系统。结果:应用logistic回归分析确定普胸术后发生快速性心律失常的风险因素为:术前肺功能(P<0.01)、术前心功能(P<0.01)、手术类别(P<0.01)和手术时间(P<0.01)。根据心律失常发生可能性方程,建立普胸术后快速性心律失常发生危险评分系统如下:术前肺功能异常(10分)、术前心功能异常(8分)、肺和食管切除手术(26分)、手术时间≥4 h(12分);根据方程预测率来绘制ROC曲线,所对应的预测普胸术后发生快速性心律失常的风险得分为26分,敏感度为92.4%,特异度为51.4%,26分以下的心律失常发生率为14.6%(27/185),26分以上的发生率为52.9%(120/227),两者比较差异有统计学意义(P<0.01)。结论:普胸术后快速性心律失常预警评分系统简单易行,结果比较可靠,能给术后心律失常的早期干预提供帮助。

Objective： To analysis the risk factor of tachyarrhythmia after general t horacic surgery （GTS）, establish the scoring system that predicts the occurrence rate of tachyarrhythmia. Methods： Retrospective study was performed on 412 patients who underwent GTS in our department. Results： Occurrence rate was 35.6%, the risk factor of tachyarrhythmia after GTS included preoperative lung function （P〈0.01）, preoperative cardiac function （P〈0.01）, surgery （P〈0.01）, surgery time （P〈0.01）. Calculated the possible function of tachyarrhythmia occurrence rate and established the scoring system with abnormal preoperative lung function （yes 10, no 0）, abnormal preoperative cardiac function （yes 8, no 0）, pulmonectomy or oesophagectomy （yes 26, no 0）, surgery time （ ≥4 h 12, 〈4 h 0）. 26 predicted the tachyarrhythmia, with sensitivity 0.924, specificity 0.514. Occurrence rate blow 26 was 14.6%, above 26 was 52.9% （P〈0.01）. Conclusion： The scoring system that predicts tachyarrhythmia occurrence rate is simple, convenient and applicable.