剖胸手术围术期心律失常原因的探讨

A Study of the Causes of Arrhythmia during Pel-operation of Thoracotomy

目的:探讨剖胸手术患者围术期发生心率失常的原因。方法:回顾分析623例剖胸手术患者围手术期心电监护纪录结果,分析心率失常发生的时间及心率失常的性质等。结果:①心率失常的发生率为27％,其中窦速64.3％,房早10.1％,室早13.1％。②心率失常发生时间:全麻插管时2.9％,开胸探查时10.1％,分离切除病灶时4.1％,术后24h43.4％,术后48h19.7％,术后72h7.8％。结论:剖胸手术围术期心率失常的发生与以下因素有关:①手术创伤,手术操作刺激及麻醉深度不足;②术中缺氧;③患者高龄;④低钾血症;⑤术后疼痛刺激;⑥术前并发有心血管疾病及心电图异常,或合并有其它慢性疾病。

Objective: To study the causes of arrhythmia during peroperation of thoracotomy. Methods: The records of ECG monitoring of 623 patients receiving thoracotomy were retrospectively analysed, and the time when the arrhythmia happened and property of arrhythmia were studied. Results: ①incidence rate of arrhythmia was 27% , in which sinus tachycardia was 64.3% , atrial premature beats 10.1% ,ventricular premature beats 13.1% .②The time of arrhythmia:at intubation of general anesthesia 2.9% ,at exploratory after thoracotomy 10.1%,when isolating and receding focus 4.1%,24,48 and 72 hours after operation respectivly 43.4%, 179.7% and 7.8% .Conclusion:The causes of arrhythmia during peroperation of thoracotomy are relative with the factors below:①Trauma of operation, stimulation during operation and light general anesthesia;②anoxemia during operation;③the patients are older;④hypokalemia;⑤stimulation of pain after operation; ⑥the patients suffered from angiocardiopathy, or normal ECG, or other chronic diseases.