Perioperative Ventricular Dysrhythmias in Patients with Structural Heart Disease Undergoing Noncardiac Surgery
Perioperative Ventricular Dysrhythmias in Patients with Structural Heart Disease Undergoing Noncardiac Surgery
复制标题
接受非心脏手术的结构性心脏病患者围术期室性心律失常
作者：
E. Mahla;B. Rotman;P. Rehak;J. L. Atlee;H. Gombotz;J. Berger;W. List;W. Klein;H. Metzler
术前有室性心律失常和结构性心脏病的非心脏手术患者可能会增加不良心脏结局的风险。我们评估了麻醉和手术如何影响室性心律失常的病程（室性早搏[PVB]和重复形式的室性搏动[RFVB]：偶联和非持续性室性心动过速）术前注意到结构性心脏病患者，以及室性心律失常的频率是否影响心脏结局。在一项前瞻性研究中，70例术前霍尔特心电图显示有结构性心脏病和RFVB的非心脏手术患者在术中和术后3天连续监测。分析霍尔特描记的节律、每小时总PVB和RFVB的中位数。35%的患者术前RFVB在术中复发，87%的患者术后复发。术中和术后每小时总PVB（P < 0.05）和每小时RFVB（P < 0.01）显著降低。5例不良结局患者（不稳定型心绞痛，n = 1;充血性心力衰竭，n = 4）的室性心律失常频率与良好结局患者无显著差异。我们的结论是，在非心脏手术的结构性心脏病和RFVB患者，室性心律失常的频率是不相关的不良心脏结局。含义：采用连续心电图监测，我们研究了围手术期室性心律失常的频率是否独立影响接受非心脏手术的结构性心脏病患者的预后。不良结局患者围手术期心律失常的发生率（8%）与良好结局患者无差异。
Noncardiac surgical patients with preoperative ventricular dysrhythmias and structural heart disease may be at increased risk of adverse cardiac outcome.We evaluated how anesthesia and surgery affect the course of ventricular dysrhythmias (premature ventricular beats [PVB] and repetitive forms of ventricular beats [RFVB]: couplets and nonsustained ventricular tachycardia) noted preoperatively in patients with structural heart disease and whether the frequency of ventricular dysrhythmias affects cardiac outcome. In a prospective study, 70 patients scheduled for noncardiac surgery with structural heart disease and RFVB on preoperative Holter electrocardiogram were continuously monitored intraoperatively and for 3 days postoperatively. Holter tracings were analyzed for rhythm, medians of total PVB and RFVB per hour. Preoperative RFVB recurred intraoperatively in 35% and postoperatively in 87% of patients. There was a significant intra- and postoperative decrease of total PVB per hour (P < 0.05) and RFVB per hour (P < 0.01). Frequency of ventricular dysrhythmias in the five patients suffering adverse outcome (unstable angina, n = 1; congestive heart failure, n = 4) did not significantly differ from those with good outcome. We conclude that in noncardiac surgical patients with structural heart disease and RFVB, the frequency of ventricular dysrhythmias is not associated with adverse cardiac outcome. Implications: Using continuous electrocardiogram monitoring, we investigated whether the frequency of perioperative ventricular dysrhythmias independently affects outcome in patients with structural heart disease undergoing noncardiac surgery. The incidence of perioperative dysrhythmia in patients with an adverse outcome (8%) did not differ from those with a good outcome.
接受非心脏手术的患者发生室性心律失常。
DOI：
10.1001/jama.268.2.217
发表时间：
1992
期刊：
JAMA
影响因子：
--
作者：
O'Kelly,B;Browner,WS;Massie,B;Tubau,J;Ngo,L;Mangano,DT
通讯作者：
Mangano,DT