老年肺癌术后并发心律失常的相关因素分析

Correlation factors in elderly patients with lung cancer complicated by postoperative arrhythmia

目的探究老年肺癌患者（≥70岁）术后并发心律失常的相关因素，并制定相应护理干预。方法选取2009年1月～2014年1月于武汉市第十一医院行原发性肺癌切除术的212例老年患者，根据术后是否发生与术前不同的心律失常（房性早搏、室性早搏、窦性心动过速、阵发性室上性心动过速、室性心动过速、心房纤颤、心室颤动以及房室传导阻滞）分为心律失常组37例和无心律失常组175例。回顾性分析患者的临床资料，比较两组性别构成比、年龄、疾病史、吸烟史、术前心电图是否异常、左室射血分数（LVEF）、一秒用力呼气容积（FEV1）及肿瘤特性上的差异，采用多因素Logistic分析，探究老年肺癌患者术后并发心律失常的相关因素。结果入组的212例老年原发性肺癌术后患者年龄范围70～81岁，平均（72.2±3.6）岁，男性172例，女性40例。心律失常组年龄大于75岁以及合并心血管疾病的比例明显高于无心律失常组（P＜0.05），两组患者在性别构成比和吸烟史方面差异无统计学意义（P＞0.05）；心律失常组术前检查心电图异常、LVEF＜50%及FEV1＜1.5L的比例均明显高于无心律失常组（P＜0.05）；两组患者的肿瘤部位、分期以及病理类型差异无统计学意义（P＞0.05）。经Logistic多因素回归分析表明患者年龄、心血管疾病史、LVEF及FEV1均为高龄肺癌患者术后发生心律失常的相关因素。结论对于需行手术治疗的高龄肺癌患者，应在术前对其心肺功能综合评估，并根据具体情况给予围术期优质护理，术后密切监测生命体征，避免由心律失常所致的不良后果。

Objective To study the correlation factors in elderly patients (age≥70) with lung cancer complicated by postoperative arrhythmia, and draw up corresponding nursing interventional strategies. Methods The elderly patients with primary lung cancer (n=212) were chosen after surgery from Jan. 2009 to Jan. 2014, and then divided, according to whether or not they had arrhythmia [atrial premature beats (APB), ventricular premature beat (VPB), nodal tachycardia, paroxysmal supraventricular tachycardia (PSVT), ventricular tachycardia, atrial fibrillation and atrioventricular block], into arrhythmia group (n=37) and non-arrhythmia (n=175). The clinical data of the patients were retrospectively analyzed, and differences in sex constituent ratio, age, disease history,smoking history, pre-operation electrocardiogram (ECG), left ventricular ejection fraction (LVEF), 1-second forced expiratory volume (FEV1) and tumor features were compared between 2 groups. The risk factors correlated to postoperative arrhythmia were studied by using multi-factor Logistic analysis. Results All 212 patients were aged from 70 to 81 and average age was (72.2±3.6), and among them 172 were male patients and 40 were female ones. The percentages of patients was older than 75 and had cardiovascular diseases were significantly higher in arrhythmia group than those in non-arrhythmia group (P<0.05), and the differences in sex constituent ratio and smoking history had no statistical significance between 2 groups (P>0.05). The examination of pre-operation ECG was abnormal in arrhythmia group, and the percentages of patients with LVEF<50% and patients with FEV1<1.5 L were significantly higher in arrhythmia group than those in non-arrhythmia group (P<0.05). The differences in tumor locations, phases and pathological types had no statistical significance between 2 groups (P>0.05). The results of multi-factor Logistic analysis showed that age, history of cardiovascular diseases, LVEF and FEV1 were risk factors correlated to postoperative arrhythmia in elderly patients with lung cancer. Conclusion The elderly patients with lung cancer who need surgical treatment should be given a comprehensive review on heart and lung functions, and better perioperative nursing service according their conditions. After surgery, patients’ vital signs should be closely monitored for avoiding the adverse results due to arrhythmia.