内科胸腔镜术中心脏并发症危险因素分析  

Analysis of risk factors on cardiac complications during thoracoscopic surgery

作　　者：刘国梁[1] 薛立福[2] 

机构地区：[1]卫生部中日友好医院呼吸科,北京100029 [2]山东省立医院呼吸科,山东济南100250

出　　处：《中国医学工程》2007年第12期960-963,共4页China Medical Engineering

摘　　要：目的研究局部麻醉下内科胸腔镜术中心脏并发症危险因素,并探讨相应对策。方法监测15例接受开放式胸腔镜术患者术前术中血压、心率、动脉血气指标(pH值、PaO2、SaO2、BE、PaCO2)、脉搏氧饱和度(SpO2)、心电图(electrocardiogram,ECG)及非术侧卧位肺功能,Logistic回归分析心脏并发症危险因素。结果①15例患者中有10例术中出现一过性ECG变化:术中S-T段较术前升高或降低≥0.1mV和/或出现室性早搏≥5次/min,其中9例发生于术中前30min内。②发生ECG变化者术前及术中心率、血压、心肌耗氧指数(收缩压×心率)、SpO2、血气指标与未发生者无明显差异(P>0.05)。③术中胸腔内吸引及疼痛与心脏并发症的发生无相关性(P>0.05),不是心脏并发症的危险因素(P>0.05)。④发生心脏并发症者术中非术侧卧位肺活量(vital capacity,VC)、VC占预计值%、一秒钟用力呼气量(forced expiratory volume in one second,FEV1)比未发生者明显减少,差异有显著统计学意义(P<0.05);心脏并发症的发生与术中VC<1.0L、FEV1<0.5L高度相关(P<0.05)。结论内科胸腔镜术中ECG变化多为一过性,但对于心肺功能差者应提高警惕;术中疼痛和胸腔内吸引不是内科胸腔镜术中心脏并发症危险因素;内科胸腔镜术中心脏并发症的发生与患者术中肺功能减低有关,术中VC<1.0L、FEV1<0.5L时心脏并发症可能性增加。[Objective] To study the risk factors on cardiac complication in open thoracoscopy under local anesthesia and consider the countermeasures. [Methods] Fifteen patients＇ blood pressure, respiratory frequency, cardiac rhythm and frequency, ECG, SpO2, arterial blood gas （ABG） were measured before, during, and after the thoracoscopic surgery. [Results] ①10 patients with cardiac complications, transient myocardial ischemia and/or ventricular premature beat were found. ②There was no significant variation of blood pressure, respiratory frequency, cardiac rhythm and frequency, myocardial oxygen consumption index, SpO2, arterial blood gas （ABG） between the patients, who had the cardiac complications during the operation and those who had no the complications （P 〉0.05）. ③The pain and aspiration during the operation had no significantly correlation with the ECG variation （P 〉0.05） and were not the risk factors of the ECG variation （P 〉0.05）. ④The para-operation pulmonary function （VC, VC%, FEV1） of the patients who had the variation of ECG were significantly lower than those of no complication patients （P 〈0.05）. The cardiac incidence had significant correlation with para-operation VC〈I.0 L, FEV,〈0.5 L. [Conclusion] ①The variation of ECG during the medical thoracoscopy procedure are transient, but more caution should be paid in some cases. ②Pain and aspiration during the operation were not the risk factors of the ECG variation. ③The cardiac incidences are associated with the decline of pulmonary function during the procedure. The cardiac complication may increase, due to VC〈1.0 L, FEV1〈0.5 L in operation.

关 键 词：胸腔镜术 侧卧位肺功能 危险因素 

分 类 号：R541[医药卫生—心血管疾病]