CAJ | 학술논문

目的总结和探讨肝移植术后近期各类心律失常的发生率、原因及其诊治方法.方法回顾性分析北京佑安医院2004年6月至2012年1月间500例次肝移植病例术后近期(术后2周内)各种心律失常的发生率及其诊治资料.结果在500例肝移植病例中,有82例(16.4％)患者发生各类心律失常,其中病态窦房结综合征(包括持续而显著的窦性心动过缓)35例(7.0％),阵发性室上性心动过速18例(3.6％),心房颤动21例(4.2％),室性心动过速8例(1.6％,包括2例尖端扭转型室性心动过速)；其中发生心脏骤停4例(0.8％),由心律失常引起的死亡2例(0.4％).心律失常主要与既往有心脏病史有明显关系(x2=15.82,P＜0.01),与终末期肝病自主神经功能紊乱、术前心电图提示QT间期延长有明显关系(x2=11.00,P＜0.01).结论心律失常是肝移植术后常见的并发症,甚至可导致死亡.术前的仔细评估,术后维持水电解质、酸碱平衡稳定,对于既往有心脏病史及术前心电图提示QT间期延长的患者应加强监测和评估、并给予预防性措施如安置临时心脏起搏器以防止术中及术后心血管意外的发生.
목적 총결화탐토간이식술후근기각류심률실상적발생솔、원인급기진치방법.방법 회고성분석북경우안의원2004년6월지2012년1월간500례차간이식병례술후근기(술후2주내)각충심률실상적발생솔급기진치자료.결과 재500례간이식병례중,유82례(16.4％)환자발생각류심률실상,기중병태두방결종합정(포괄지속이현저적두성심동과완)35례(7.0％),진발성실상성심동과속18례(3.6％),심방전동21례(4.2％),실성심동과속8례(1.6％,포괄2례첨단뉴전형실성심동과속)；기중발생심장취정4례(0.8％),유심률실상인기적사망2례(0.4％).심률실상주요여기왕유심장병사유명현관계(x2=15.82,P＜0.01),여종말기간병자주신경공능문란、술전심전도제시QT간기연장유명현관계(x2=11.00,P＜0.01).결론 심률실상시간이식술후상견적병발증,심지가도치사망.술전적자세평고,술후유지수전해질、산감평형은정,대우기왕유심장병사급술전심전도제시QT간기연장적환자응가강감측화평고、병급여예방성조시여안치림시심장기박기이방지술중급술후심혈관의외적발생.
Objective To summarize and investigate the incidence,reason,diagnosis and treatment of postoperative early cardiac arrhythmia after orthotopic liver transplantation(OLT).Method A retrospective study was made for the incidence,dignosis and treatment of cardiac arrhythmia (two weeks after OLT) following OLT from June 2004 to January 2012 in the Beijing You-An Hospital.Results In 500 patients who received OLT,Cardiac arrhythmia developed in 82 patients (16.4％).Among these cardiac arrhythmia,35(7.0 ％) were sick sinus syndrome (including severe sinus bradycardia ),18 (3.6 ％ ) were paroxysmal supraventricular tachycardia,21(4.2 ％) were atrial fibrillation,8(1.6 ％,including 2 patients with torsades de pointes) were ventricular tachycardia and 4 (0.8 ％ )were cardiac arrest.Mortality rate after OLT relate to cardiac arrhythmia was 0.4％ (2 patients).Cardiac arrhythmia was mainly correlated with four factors:(1)whether patient had heart disease before OLT or not(x2 =15.82,P＜0.01),(2)Prolonged QT interval in patients with end-stage liver disease before OLT(x2 =11.00,P＜0.01).Conclusions Cardiac arrhythmia was common complication after OLT,and it can lead to death of recipients.Careful evaluation to recipients before OLT,controlling fluid load after OLT,keeping the balance of the electrolyte,acidity and alkalescence,giving intensive monitor to patients with heart disease before OLT and prolonged QT interval are the key factor to reduce incidence and mortality of cardiac arrhythmia.Application of medication and cardiac pacemaker can prevent cardiovascular accident after OLT.