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目的探讨高龄(≥70岁)肺癌患者术后心律失常的病因。方法回顾性分析自2001年3月至2008年5月经手术治疗高龄(≥70岁)肺癌患者355例,术后全部在ICU用多功能生命监护仪连续监护72h以上。结果术后发生心律失常223例,发生率为62.8%。术前心电图异常者,术后心律失常发生率为74.5%(172/231),明显高于术前心电图正常者的45.2%(56/124)(P<0.05)。全肺切除术后心律失常发生率为87.8%(43/49),明显高于肺叶切除、肺楔形切除和剖胸探查术后的58.1%(178/306)(P<0.05)。术前有重度吸烟史者术后心律失常发生率为78.4%(156/199),明显高于非重度吸烟史者的43%(67/156)(P<0.05)。术前有心血管病史者术后心律失常的发生率为72.2%(190/263),明显高于无心血管病史者的38%(35/92)(P<0.05)。结论术前有心电图异常、有心血管病史、有重度吸烟史及行全肺切除是高龄肺癌患者术后心率失常的重要因素。
Objective To investigate the etiology of postoperative arrhythmia in elderly patients (≥70 years) with lung cancer. Methods From March 2001 to May 2008, 355 patients with advanced lung cancer (≥70 years) surgically treated were retrospectively analyzed. All ICU patients were continuously monitored for more than 72 hours with multi-functional life monitor after operation. Results The postoperative arrhythmia occurred in 223 cases, the incidence was 62.8%. Preoperative ECG abnormalities, the incidence of postoperative arrhythmia was 74.5% (172/231), significantly higher than the preoperative ECG was 45.2% (56/124) (P <0.05). The incidence of arrhythmia after total pneumonectomy was 87.8% (43/49), which was significantly higher than that of lobectomy, wedge resection and dissection (58.1%, 178/306) (P <0.05). The incidence of postoperative arrhythmia was 78.4% (156/199) in patients with severe smoking before operation, which was significantly higher than 43% (67/156) in non-severe smoking history (P <0.05). The incidence of postoperative arrhythmia in preoperative cardiovascular history was 72.2% (190/263), significantly higher than 38% (35/92) in patients without cardiovascular disease (P <0.05). Conclusions Preoperative electrocardiogram abnormalities, cardiovascular history, severe smoking history and total pneumonectomy are important factors of postoperative arrhythmia in elderly patients with lung cancer.