老年肺癌患者术后心律失常的相关因素分析  

Correlation analysis on risk factors of postoperative cardiac arrhythmia in lung cancer with senile patients

作　　者：刘永靖[1] 于奇[1] 疏元善[1] 韩继彪[1] 缪军[1] 陶宇[1] 刘宏[1] 张俊峰[1] 

机构地区：[1]安徽医科大学解放军临床学院(解放军105医院)心胸外科,合肥230031

出　　处：《安徽医科大学学报》2009年第2期253-256,共4页Acta Universitatis Medicinalis Anhui

摘　　要：目的探讨老年肺癌患者术后发生心律失常的相关因素及处理方法。方法手术治疗347例≥65岁肺癌患者,全肺切除术97例,肺叶切除术219例,楔型切除术24例,开胸探查术7例。术后发生心律失常113例,分析影响术后发生心律失常可能的相关因素。结果心律失常总发生率为32.6%,吸烟史、心律失常史、术前心肺功能、手术方式、术中低血压、手术时间、术后肺部感染、肺不张是术后心律失常的主要危险因素(P<0.01),术后镇痛是保护因素(P=0.001)。结论老年人心肺储备功能降低、对手术损伤及缺氧的耐受力降低是导致术后心律失常的原因,采取预防措施可减少其发生率。对于高危患者,术前应着重改善心肺功能、戒烟;术中应减少损伤、缩短手术时间;术后应加强心电监护、充足氧供、减轻疼痛和有效排痰。Objective To analyze the risk factors of postoperative cardiac arrhythmia of senile patients suffering lung cancer and explore the prophylaxis. Methods Logistic regression analysis with the risk factors of postoperative cardiac arrhythmia in 347 cases undergoing operation for lung cancer patients with age of more than 65 years old, those included 97 cases with pneumonectomy, 219 cases with lobectomy, 24 cases with wedge resection and 7 cases with exploratory thoracotomy. Arrhythmia postoperation occurred in 113 cases. Results The overall chance of arrhythmia was 32.6%. The risk factors included history of smoking and arrhythmia, preoperative pulmonary and heart function, surgery way, hypotension, prolonged operation, postoperative pneumonia and pulmonary closure, which were identified by muhifactor no-conditional logistic regression （P 〈 0. 01 ）. The protective factor was postoperative analgesia （P = 0. 001 ）. Conclusion The causes of arrhythmia are decrease of cardiac and lung reserve function, and surgical injury and decreased tolerance to hypoxia. Some prophylactic measure would reduce the occurrence of arrhythmia. The prophylaxis should focus on improvement of heart and lung functions, quitting of smoking before operation, shortening operation procedure and minimizing injuries during operation; close electrocardiographic monitoring, oxygen supply, pain - relief and sputum removal after operation.

关 键 词：肺肿瘤/外科学 心律失常 手术并发症 危险因素 

分 类 号：R655.3[医药卫生—外科学] R734.2[医药卫生—临床医学]