食管癌患者术后并发心房颤动的临床分析  

Clinical Analysis of Patients with Atrial Fibrillation after Surgical Treatment for Esophageal Carcinoma

作　　者：王允[1] 赵雍凡[1] 刘华英[1] 李勇[1] 谢天鹏[1] 解晨昊[1] 付茂勇[1] 

机构地区：[1]四川大学华西医院胸心血管外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2005年第1期11-14,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金资助项目 (3 0 10 0 181) ;四川大学青年科技基金资助项目 (2 0 0 3 0 3 5 )~~

摘　　要：目的　探讨食管癌患者术后发生心房颤动 (AF)的高危因素、临床处理及其对围术期预后的影响。　方法收集 6 3例食管癌术后发生 AF患者的临床资料 (AF组 ) ,并以同期手术的 12 6例食管癌术后未发生 AF的患者做对照 (对照组 ) ,采用χ2 检验和 logistic回归分析可能导致 AF的高危因素 ,比较两组患者的术后住院时间及围术期死亡率。　结果　 AF组中 6 5岁以上 (χ2 =7.0 2 ,P<0 .0 1)、男性 (χ2 =4 .0 6 ,P<0 .0 5 )、术前合并心脏病 (χ2 =6 .0 3,P<0 .0 5 )或慢性阻塞性肺疾病 (χ2 =2 9.14 ,P<0 .0 1) ,以及术后低氧饱和度 (P<0 .0 1)、胸胃扩张 (P<0 .0 1)患者的比例显著高于对照组 ,而术前合并糖尿病、高血压以及手术入路、吻合口部位等与 AF的发生无相关性 (P>0 .0 5 ) ;去除AF诱发因素后自动恢复窦性心律的比例为 6 .6 7% (1/ 15 ) ,其余 6 2例患者均使用药物复律 ;两组患者的围术期死亡率及术后住院时间差别无统计学意义 (P>0 .0 5 )。　结论　高龄、男性以及术前合并心脏病、慢性阻塞性肺疾病的患者在行食管癌术后容易发生 AF,术后低氧饱和度、胸胃扩张是诱发 AF的危险因素 ,但只要及时发现、治疗 ,AF不会增加围术期死亡率和术后住院时间。Objective To investigate the high risk factors for perioperative atrial fibrillation （AF） and its effect on the postoperative short term outcome in esophageal carcinoma patients. Methods Sixty-three patients with AF after esophagectomy （AF group） and 126 patients without AF after esophagectomy in control group were analyzed by X^2, and logistic regression, and compare with patient the postoperative mortality and duration hospitalization in two groups. Results The rates of age above 65 （X^2=7.02, P〈0.01）, male sex （X2=4.06, P〈0. 05）, history of. cardiac disease （X^2=6.03, P〈0. 05）, history of chronic obstructive pulmonary disease （COPD, X^2=29. 14,P〈 0.01）, postoperative thoracic-gastric dilatation （P〈0.01）, and postoperative lower oxygen saturation （P〈0.01） in AF group were significantly higher than those in control group. No significant relevance was found between history of diabetes or hypertension, choice of operative approach, site of stoma and postoperative AF. 1 in 15 AF patients regain sinus rhythm after remove the pathological factors, and the others resumed after antiarrhythmic drug therapy. The postoperative hospitalization time was 10. 65±0. 87 d in patients developing AF group and 9. 98±0. 96 d in control group （P〉0.05）. No difference was observed between two groups with regard to mortality （P〉0.05）.Conclusion AF occurs more frequently after esophagectomyin aged and male sex. Other factors contributing to AF are history of cardiac disease, COPD and lower oxygen saturation. And in this study, early occurrence of AF after operation for esophageal carcinoma does not show any negative impact on mortality or on postoperative duration hospitalization.

关 键 词：食管癌 心房颤动 外科手术 

分 类 号：R735.1[医药卫生—肿瘤]