500例肝移植术后近期各种心律失常的原因及诊治  

The reason, diagnosis and treatment of postoperative early cardiac arrhythmia in 500 patients who re- ceived orthotopic liver transplantation

作　　者：王鑫[1] 卢实春[1] 王孟龙[1] 林栋栋[1] 池萍[1] 刘晋宁[1] 李宁[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝移植中心,100069

出　　处：《中华肝胆外科杂志》2012年第7期532-534,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：北京市卫生系统高层次卫生技术人才培养计划学科带头人基金（2011-2-18）

摘　　要：目的总结和探讨肝移植术后近期各类心律失常的发生率、原因及其诊治方法。方法回顾性分析北京佑安医院2004年6月至2012年1月间500例次肝移植病例术后近期（术后2周内）各种心律失常的发生率及其诊治资料。结果在500例肝移植病例中，有82例（16．4％）患者发生各类心律失常，其中病态窦房结综合征（包括持续而显著的窦性心动过缓）35例（7．0％），阵发性室上性心动过速18例（3．6％），心房颤动21例（4．2％），室性心动过速8例（1．6％，包括2例尖端扭转型室性心动过速）；其中发生心脏骤停4例（0．8％），由心律失常引起的死亡2例（0．4％）。心律失常主要与既往有心脏病史有明显关系（χ^2=15．82，P〈0．01），与终末期肝病自主神经功能紊乱、术前心电图提示QT间期延长有明显关系（χ^2=11．00，P〈0．01）。结论心律失常是肝移植术后常见的并发症，甚至可导致死亡。术前的仔细评估，术后维持水电解质、酸碱平衡稳定，对于既往有心脏病史及术前心电图提示QT间期延长的患者应加强监测和评估、并给予预防性措施如安置临时心脏起搏器以防止术中及术后心血管意外的发生。Objective To summarize and investigate the incidence, reason, diagnosis and treat- ment of postoperative early cardiac arrhythmia after orthotopic liver transplantation（OLT）. Method A retrospective study was made for the incidence, dignosis and treatment of cardiac arrhythmia （two weeks after OLT） following OLT from June 2004 to January 2012 in the Beijing You-An Hospital. Results In 500 patients who received OLT, Cardiac arrhythmia developed in 82 patients （16.4%）. Among these cardiac arrhythmia, 35（7. 0%） were sick sinus syndrome （including severe sinus brady- cardia ）, 18 （3.6% ） were paroxysmal supraventricular tachycardia, 21 （4.2 % ） were atrial fibrillation, 8 （1.6% ,including 2 patients with torsades de pointes） were ventricular tachycardia and 4 （0.8 %）were cardiac arrest. Mortality rate after OLT relate to cardiac arrhythmia was 0.4% （2 patients）. Cardiac arrhythmia was mainly correlated with four factors： （1）whether patient had heart disease before OLT or not（x2= 15.82, P〈0.01）, （2）Prolonged QT interval in patients with end-stage liver disease be- fore OLT（x2=11.00, P〈0.01）. Conclusions Cardiac arrhythmia was common complication after OLT,and it can lead to death of recipients. Careful evaluation to recipients before OLT, controlling fluid load after OLT, keeping the balance of the electrolyte, acidity and alkalescence, giving intensive monitor to patients with heart disease before OLT and prolonged QT interval are the key factor to re- duce incidence and mortality of cardiac arrhythmia. Application of medication and cardiac pacemaker can prevent cardiovascular accident after OLT.

关 键 词：肝移植 心律失常 因果律 

分 类 号：R657.3[医药卫生—外科学]