手术术式对肺癌肺切除术后并发心律失常的影响

Effect of surgical operation on cardiac arrhythmia after pulmonary resection of lung cancer

目的探讨不同术式对肺癌肺切除术后并发心律失常的影响。方法回顾分析我院277例肺癌肺切除术患者的临床资料,其中全肺切除77例,肺叶切除151例,肺楔形切除49例。常规肺切除术218例,经心包切除术59例。采集既往病史,检查心、肺功能和心电图;监测并记录术后各种心律失常的发生情况、生命体征的变化以及围术期其他观察指标,分析肺癌肺切除术后并发心律失常的相关危险因素以及不同手术方式对术后并发心律失常的影响。结果 1 277例肺癌患者肺切除术后132例发生心律失常,发生率为47.65%。2年龄≥60岁,吸烟嗜好、合并呼吸系统疾病、冠心病,既往有心律失常史以及肺功能检查FEV1/FVC<70%、超声心动图检查EF≤50%或舒张功能不全是肺癌患者肺切除手术后并发心律失常的危险因素(P<0.05)。3全肺切除术、肺叶切除术和楔形切除术三种不同术式整体比较心律失常的发生率差异有显著统计学意义(P<0.01),对比研究显示全肺切除术心律失常发生率明显高于肺叶切除术和楔形切除术(P均<0.01),肺叶切除术心律失常发生率高于楔形切除术,差异有显著统计学意义(P<0.05);全肺切除术后窦性心动过速、房颤和室早的发生率均显著高于肺叶切除术和楔形切除术(P<0.01);经心包切除术心律失常的发生率显著高于常规切除术患者(P<0.01);经心包肺切除术后窦性心动过速、房颤、室性早搏的发生率亦明显高于常规切除术患者(P<0.05)。结论手术方式与术后心律失常发生关系密切,是肺癌肺切除术后心律失常发生和加重的主要诱发因素。科学合理个体化选择肺切除手术方式、切除部位及范围是避免术后心律失常发生的主要手段。

Objective To investigate the effects of different operations on cardiac arrhythmia after pulmo-nary resection of lung cancer. Methods The clinical data of 277 patients undergoing pulmonary resection of lung cancer, including 77 patients of pneumonectomy, 151 patients of lobectomy, and 49 patients of pulmonary wedge re-section, were retrospectively analyzed. Among the 277 patients, 218 received routine pulmonary resection and 59 were treated by resection of pericardium. Medical histories of the patients were collected, and heart and lung function, ECG were examined. The occurrence and status of cardiac arrhythmia were monitored and recorded, as well as the changes of vital signs, and other indicators in perioperative period. The the risk factors of cardiac arrhythmia after pulmonary resection of lung cancer and the effect of different operation modes on concurrent arrhythmia after operation were ana-lyzed. Results ①Among the 277 patients, 132 had cardiac arrhythmia after pulmonary resection of lung cancer, with the incidence of 47.65%.②With age≥60 years, smoking habits, combined with respiratory system disease, cor-onary heart disease, previous history of arrhythmia and FEV1/FVC〈70% in pulmonary function tests, EF≤50% in ultrasonic heartbeat map check or diastolic dysfunction were the risk factors for cardiac arrhythmia （P〈0.05, 0.01）.③There was statistically significant difference in the incidence of cardiac arrhythmia among three kinds of operation modes：pneumonectomy, lobectomy and wedge resection （P〈0.01）. The incidence was significantly higher for pneu-monectomy than lobectomy and wedge resection （P〈0.01）, and also for lobectomy than wedge resection （P〈0.05）. Af-ter pneumonectomy, the incidence of sinus tachycardia, atrial fibrillation, ventricular premature beat was significantly higher than that of lobectomy and wedge resection （P〈0.01）. The incidence of arrhythmia were significantly higher in pericardial resection than conventional resection （P〈0.01）, as well as the incidence of sinus tachycardia, atrial fibrilla-tion, ventricular premature beat （P〈0.05）. Conclusion The operation mode is closely related to postoperative arrhyth-mia, and it is the main cause of the occurrence and aggravating of arrhythmia after pulmonary resection of lung cancer. Scientific and rational individualized selection of lung resection operation mode, the location and extent of resection is the main method to reduce or avoid the occurrence of arrhythmia after operation.