COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer
COPD may increase the incidence of refractory supraventricular arrhythmias following pulmonary resection for non-small cell lung cancer
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DOI：
10.1378/chest.120.6.1783
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发表时间：
2001-12-01
期刊：
影响因子：
9.6
通讯作者：
Brown, JW
中科院分区：
文献类型：
--
作者：
Sekine, Y;Kesler, KA;Brown, JW
目的：本研究调查了COPD和术后心律失常，特别是室上性心动过速（SVT），以及非小细胞肺癌（NSCLC）肺切除术患者的死亡率之间的关联：方法：回顾性图表审查244例谁经历了肺切除术的非小细胞肺癌在印第安纳州大学医院1992年和1997年之间进行。根据术前肺功能检查（PFT）结果，COPD定义为FEV 1小于或等于70%预测值，且FEV 1/FVC比值小于或等于70%，244例患者中有78例（COPD组）被诊断为COPD。在其余166例患者中，术前PFT的结果不符合这些标准（非COPD组）。两组在多个变量方面匹配良好，包括年龄、合并症、肺切除范围和最终病理分期。结果：术后76例（31.9%）发生室上性心动过速，其中58例（76.3%）发生房颤，术后12例（31.9%）发生室上性心动过速。COPD组SVT的发生率为58.7%（n = 44），而非COPD组为27.0%（n = 44）（p < 0.001）。此外，初始地高辛治疗后，COPD组比非COPD组需要更多的二线抗抑郁治疗（分别为66.7%和37.8%; p = 0.003）。总体而言，有16例手术死亡（6.6%），COPD组的死亡率（14.1%）显著高于非COPD组（3.0%; p = 0.004）。发生室上性心动过速的患者比未发生室上性心动过速的患者住院时间明显延长（p < 0.0001）。16例死亡患者中有13例发生了SVT;然而，SVT不是死亡的独立风险因素。最后，在评价的19个变量中，（即肺切除术和双叶切除术）和COPD被确定为发生心律失常的独立危险因素（分别为p = 0.0 033和p = 0.0 009）。根据术前PFT结果定义的COPD患者发生SVT的风险显著较高，特别是地高辛难治性SVT，在NSCLC的肺切除术后。虽然SVT不是死亡的独立危险因素，但观察到住院时间明显延长。
Purpose: This study investigated the association of COPD and postoperative cardiac arrhythmias, specifically supraventricular tachycardia (SVT), as well as mortality in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC).Methods: A retrospective chart review of 244 patients who had undergone lung resection for NSCLC at Indiana University Hospital between 1992 and 1997 was undertaken. COPD, which was defined as an FEV1 of less than or equal to 70% predicted and an FEV1/FVC ratio of less than or equal to 70% based on the results of a preoperative pulmonary function test (PFT), was diagnosed in 78 of the 244 patients (COPD group). In the remaining 166 patients, the results of preoperative PFTs did not meet these criteria (non-COPD group). Both groups were otherwise well-matched with respect to multiple variables, including age, comorbid conditions, extent of pulmonary resection, and final pathologic stage. The incidence of cardiac arrhythmias and operative mortality were compared between the two groups using univariate and multivariate analysis.Results: Seventy-six patients (31.9%) experienced new onsets of postoperative SVT, with 58 of these patients (76.3%) demonstrating atrial fibrillation. The COPD group had a 58.7% incidence of SVT (n = 44) compared to a 27.0% incidence (n = 44) in the non-COPD group (p < 0.001). Moreover, following initial digoxin therapy, the COPD group required more second-line antiarrhythmic therapy than did the non-COPD group (66.7% vs 37.8%, respectively; p = 0.003). Overall, there were 16 operative deaths (6.6%), and the mortality rate was significantly higher in the COPD group (14.1%) than in the non-COPD group (3.0%; p = 0.004). Patients who developed SVT had a significantly longer hospital course than did patients who did not (p < 0.0001). Thirteen of the 16 patients who died experienced SVT; however, SVT was not an independent ride factor for death. Finally, of the 19 variables evaluated, major resection (ie, pneumonectomy and bilobectomy) and COPD were identified as independent risk factors for the development of cardiac arrhythmias (p = 0.0 033 and p = 0.0 009, respectively).Conclusion: Patients with COPD, as defined by the results of preoperative PFTs, are at significantly higher risk for SVT, and in particular SVT refractory to digoxin, following pulmonary resection for NSCLC. Although SVT was not an independent risk factor for death, a significantly longer hospitalization was observed.