Supraventricular arrhythmia following lung resection for non-small cell lung cancer and its treatment with amiodarone.
Supraventricular arrhythmia following lung resection for non-small cell lung cancer and its treatment with amiodarone.
复制标题
非小细胞肺癌肺切除术后室上性心律失常及其胺碘酮治疗。
DOI：
10.1016/s1010-7940(00)00428-0
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Piero Zannini
中科院分区：
文献类型：
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作者：
P. Ciriaco;Patrizio Mazzone;B. Canneto;Piero Zannini
目的：1998年1月至1999年2月，对160例因非小细胞肺癌接受肺切除术的患者进行了研究，以确定增加术后室上性心律失常（SA）风险的因素，并评估胺碘酮作为抗心律失常药物的有效性。方法：所有患者均在术中和术后进行监测，直至第3天。使用ECG记录SA发作。胺碘酮给那些谁开发SA的负荷剂量为5 mg/kg，在30分钟和维持剂量为15 mg/kg，在24小时。结果：平均年龄为64岁（范围27-83岁）。楔形切除9例，肺段切除6例，肺叶切除127例，全肺切除18例。22例患者（13%）有SA，均为房颤。肺切除术和肺叶切除术的室上性心律失常发生率分别为33%和12%（P=0.02）。小切除的患者均未发生SA。SA发病高峰出现在术后第2天，持续时间1 ~ 12天，平均3.4天。胺碘酮组20例（90.9%）恢复窦性心律，无不良反应。2例患者因血流动力学不稳定接受电复律。SA患者的平均术前pO 2和pCO 2较低：pO280.8 vs. 85 mmHg（P=0.04）; pCO235.5 vs. 38 mmHg（P=0.01）。合并心肺疾病患者术后心律失常的OR值为12.4（可信区间4.5-34.1）（P <0.0001）。结论：合并心肺疾病、pO 2、pCO 2降低和手术范围增加非小细胞肺癌肺切除术后SA的风险。建议对有风险的患者进行心脏监测。胺碘酮在建立和维持窦性心律方面安全有效。
Objective: From January 1998 to February 1999, 160 patients undergoing lung resection for non-small cell lung cancer were studied to define factors that increase the risk of postoperative supraventricular arrhythmia (SA) and to assess the effectiveness of amiodarone as an antiarrhythmic drug.Methods: All patients were monitored intraoperatively and postoperatively up to day 3. Onset of SA was documented with ECG. Amiodarone was administered to those who developed SA with a loading dose of 5 mg/kg in 30 min and a maintenance dose of 15 mg/kg in 24 h.Results: Mean age was 64 years (range 27–83 years). There were nine wedge resections, six segmentectomies, 127 lobectomies and 18 pneumonectomies. Twenty-two patients (13%) had SA, all of which were atrial fibrillations. The incidence of supraventricular arrhythmia with pneumonectomy and lobectomy was 33 and 12%, respectively (P=0.02). None of the patients who had a minor resection developed SA. The peak incidence of onset of SA occurred on postoperative day 2 and lasted from 1 to 12 days (average 3.4 days). Sinus rhythm was achieved with amiodarone in 20 patients (90.9%) with no side effects. Two patients received electrical cardioversion because hemodynamically unstable. Mean preoperative pO2and pCO2were lower in patients with SA: pO280.8 vs. 85 mmHg (P=0.04); pCO235.5 vs. 38 mmHg (P=0.01). Patients with concomitant cardiopulmonary diseases presented an odds ratio for postoperative arrhythmia of 12.4 (confidence interval 4.5–34.1) (P≪0.0001).Conclusion: Concomitant cardiopulmonary diseases, lower pO2, pCO2and extent of surgery increase the risk of postoperative SA after lung resection for non-small cell lung cancer. Cardiac monitoring in patients at risk is recommended. Amiodarone was both safe and effective in establishing and maintaining sinus rhythm.