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目的:总结心脏手术后早期反复发生恶性室性心律失常的预防和处理经验。方法:回顾性分析我科2006年1月-2010年1月心内直视心脏手术后顽固性室速、室扑、室颤18例临床资料(0.25%)。术前病种包括:冠心病4例,瓣膜病11例,先心病2例,心包疾病1例。所有患者均在体外循环下行心内或心外畸形矫正术。术后反复发生恶性室性心律失常的时间为术后(4.07±3.73)d(0～11d),持续时间(3.43±1.34)d。所有患者都根据可能诱发恶性室性心律失常的原因积极处理并选择性应用抗室性心律失常的药物,无脉搏者选择胸外按压或电复律。结果:本组患者中14例经积极治疗恢复良好,死亡3例(16.67%),昏迷1例。存活者术后随访3个月,15例患者无再发恶性室性心律失常。结论:心脏手术后反复发生恶性室性心律失常可能与心脏局部非特异性水肿、酸碱平衡电解质紊乱、药物过量、巨大左心室、再发严重心肌缺血等多种因素有关。治疗应从可能导致心律失常的诱因出发,尽快去除诱因,选择适当的复律方法,并减少并发症。
Objective: To summarize the prevention and treatment of recurrent malignant ventricular arrhythmias after cardiac surgery. Methods: Clinical data (0.25%) of 18 patients with refractory ventricular tachycardia, ventricular flutter and ventricular fibrillation after open heart surgery in our department from January 2006 to January 2010 were retrospectively analyzed. Preoperative species include: coronary heart disease in 4 cases, valvular disease in 11 cases, 2 cases of congenital heart disease, 1 case of pericardial disease. All patients underwent cardiopulmonary bypass or cardiopulmonary deformity correction. Postoperative recurrence of malignant ventricular arrhythmia after surgery (4.07 ± 3.73) d (0 ~ 11d), duration (3.43 ± 1.34) d. All patients actively treated and selectively administered antiarrhythmic drugs based on the reasons that may induce malignant ventricular arrhythmias, and those without pulse chose chest compressions or cardioversion. Results: In the group of 14 patients after active treatment recovered well, 3 patients died (16.67%), coma in 1 case. Survivors were followed up for 3 months, 15 patients without recurrent malignant ventricular arrhythmias. Conclusion: Recurrent malignant ventricular arrhythmia after cardiac surgery may be related to local non-specific edema, acid-base balance electrolyte imbalance, overdose, huge left ventricle, recurrent severe myocardial ischemia and other factors. Treatment should start from the cause of arrhythmias may lead to removal of incentives as soon as possible, select the appropriate cardioversion method and reduce complications.