超高龄肺癌患者围术期心律失常的危险因素分析

摘要

Objective To study the risk factors of perioperative arrhythmia in over-aged patients with lung cancer and preventive measures.Methods Patients with lung cancer aged 75~86 years as the observation group,and 100 patients with lung cancer aged 45~65 years as the control group,all patients received pneumonectomy or lobectomy,perioperative arrhythmia be-tween the 2 groups were compared.Results In the observation group,72 cases (57.60%) had arrhythmia,in the control group, 35 cases (35.00%) had arrhythmia,there had significant difference (P<0.05).Postoperative arrhythmias multivariate logistic regression analysis showed that cardiopulmonary complications,carbon dioxide partial pressure and the extent of surgery were in-dependent risk factors.Postoperative arrhythmias lung univariate analysis showed that among surgery-related factors,surgical meth-od and surgical time>4 h had statistical significance,the whole lung resection had highest incidence of arrhythmia,and lobectomy had a lower incidence of arrhythmia.Other factors such as gender,tumor lesions,lymph node dissection positive or not had no cor-relation with the occurrence of cardiac arrhythmia in the over-aged lung cancer patients.Conclusion Age,poor heart and lung function,hysterectomy and low blood volume and postoperative pain are risk factors for arrhythmia in the over-aged lung cancer patients.Corresponding preventive care measures should be prepared to reduce the occurrence of arrhythmia.%目的：探讨超高龄肺癌患者围术期心律失常的常见危险因素及防治措施。方法选取125例75～86岁的超高龄肺癌患者作为观察组，同时选取100例年龄45～65岁的肺癌患者作为对照组，2组患者均采用全肺切除或肺叶切除，观察并比较2组患者围手术期心律失常发生情况。结果观察组患者72例（57．60％）发生心律失常，对照组35例（35．00％）发生心律失常，2组差异有统计学意义（P＜0．05）。超高龄患者术后心律失常多因素Logistic回归分析，确定心肺合并症、二氧化碳分压及手术范围是显著的三大独立危险因素。肺癌术后心律失常的手术相关因素中有手术切除方式及手术时间。全肺切除术后心律失常的发生率最高，而肺叶切除术后心律失常的发生率则较低。其它因素如性别、肿瘤病变部位、淋巴结清扫及清扫之淋巴结有无阳性则与高龄肺癌患者术后发生心律失常无相关性。结论年龄、心肺功能差、术式及低血容量等是引起超高龄肺癌患者围术期心律失常的危险因素，应做好相应的预防护理措施，减少心律失常的发生。