创伤后继发性心律失常的研究进展

Research progress of secondary arrhythmias after trauma

创伤患者并发心律失常在临床中十分常见,发生率高,更与其心肌梗死、脑血管意外、住院时间延长、医疗费用增加等不良预后相关。创伤后快速性心律失常在临床中以窦性心动过速、房颤、室上性心动过速等常见,而创伤合并低体温的患者则以心动过缓及室性心律失常多见。心律失常的发生通常是创伤相关多因素共同作用的结果,其机制涉及低血容量性休克、儿茶酚胺毒性作用、炎症及氧化反应、补体激活和细胞凋亡等。临床防治措施主要有早期容量复苏、使用血管活性药物、疼痛管理、心律失常的药物治疗等。本文就创伤后心律失常的相关文献进行回顾并作综述,为进一步临床防治提供指导。

Concurrent arrhythmia in trauma patients is very common in clinic,with a high incidence.More-over,this complication is associated with poor prognosis of myocardial infarction,cerebrovascular accident,prolonged length of hospital stay and increased medical costs.Post-traumatic tachyarrhythmia is commonly presented as sinus tachycardia,atrial fibrillation and supraventricular tachycardia;but bradycardia and ventricular arrhythmia are more common in trauma patient combined with hypothermia.The onset of arrhythmia is usually the result of multiple fac-tors related to trauma,including hypovolemic shock,catecholamine toxicity,inflammation and oxidation reactions,complement activation and apoptosis,etc.Clinical prevention and treatment measures are mainly early volume resus-citation,use of vasoactive drugs,pain management,drug therapy for arrhythmia,etc.This article reviews the litera-ture related to post-traumatic arrhythmia and makes a summary to provide guidance for further clinical prevention and treatment.