CAJ | 학술논문

目的探讨肿瘤外科ICU室上性心律失常(SVAs)的发生率及危险因素.方法回顾分析我院ICU 2008年11月至2009年10月间收治570例患者的临床资料,对SVAs可能的影响因素进行单因素和多因素Logistic分析.结果 13例有心房颤动病史的患者被除外,入选557例.SVAs发生率为12.93%(72/557).多因素分析显示年龄(OR=1.066,95%CI:I.034～1.099,P＜0.001)、冠心病病史(OR=2.644,95%CI:1.459～4.790,P＜0.05)、转入时确诊为脓毒症(OR=2.374,95%CI:1.098～5.135,P＜0.05)和胸部外科手术操作(OR=2.322,95%CI:1.061～5.084,P＜0.05)是SVAs发生的独立危险因素.SVAs患者与非SVAs组住ICU时间[2(1～77)、3(1～40)d,Z=-3.505,P＜0.001]和APACHEⅡ评分[9(0～37)、11(3～38)分,Z=-3.332,P=0.001],差异有统计学意义.SVAs组死亡9例(12.5%),非SVAs组死亡19例(3.9%),病死率差异有统计学意义(x2=9.673,P=0.002).结论肿瘤外科ICU患者术后SVAs的发生率较高,年龄、冠心病病史、转入ICU时确诊有脓毒症和胸部外科手术操作是术后SVAs发生的独立危险因素.SVAs增加患者住ICU时间,是反映患者病情严重性的一种标志.
목적 탐토종류외과ICU실상성심률실상(SVAs)적발생솔급위험인소.방법 회고분석아원ICU 2008년11월지2009년10월간수치570례환자적림상자료,대SVAs가능적영향인소진행단인소화다인소Logistic분석.결과 13례유심방전동병사적환자피제외,입선557례.SVAs발생솔위12.93%(72/557).다인소분석현시년령(OR=1.066,95%CI:I.034～1.099,P＜0.001)、관심병병사(OR=2.644,95%CI:1.459～4.790,P＜0.05)、전입시학진위농독증(OR=2.374,95%CI:1.098～5.135,P＜0.05)화흉부외과수술조작(OR=2.322,95%CI:1.061～5.084,P＜0.05)시SVAs발생적독립위험인소.SVAs환자여비SVAs조주ICU시간[2(1～77)、3(1～40)d,Z=-3.505,P＜0.001]화APACHEⅡ평분[9(0～37)、11(3～38)분,Z=-3.332,P=0.001],차이유통계학의의.SVAs조사망9례(12.5%),비SVAs조사망19례(3.9%),병사솔차이유통계학의의(x2=9.673,P=0.002).결론 종류외과ICU환자술후SVAs적발생솔교고,년령、관심병병사、전입ICU시학진유농독증화흉부외과수술조작시술후SVAs발생적독립위험인소.SVAs증가환자주ICU시간,시반영환자병정엄중성적일충표지.
Objective To evaluate the incidence and to investigate risk factors of supraventricular arrhythmia (SVAs) in postoperative cancer patients in intensive care unit ( ICU ). Methods Data of 570 patients consecutively admitted to oncologic surgical ICU of Cancer Hospital of Chinese Academy of Medical Sciences from Nov. 2008 to Oct. 2009 were retrospectively collected. Univariate and multivariate logistic analysis were conducted for potential factors that influenced SAVs. Results Thirteen patients with a history of atrial fibrillation (AF) were excluded and 557 patients were eligible for the study. SVAs occurred in 72 patients ( 12. 93% ). Multivariate analysis showed four independent predictors of SVAs including age ( OR = 1. 066,95%CI: 1. 034 - 1. 099,P ＜0. 001 ) ,a history of coronary heart diseases ( OR = 2. 644,95% CI: 1. 459 - 4. 790,P ＜ 0. 05), sepsis ( OR = 2. 374,95% CI: 1. 098 - 5. 135, P ＜ 0. 05 ) and intra-thoracic procedure ( OR =2. 322,95 % CI: 1.061 - 5.084, P ＜ 0. 05 ) . ICU length of stay, severity ( APACHE Ⅱ scores in SVAs patients) were significantly greater in patients who were not affected by SVAs ( ICU stay: [2 ( 1 ～ 77 )]vs [3 ( 1 ～ 40 )]days,P ＜ 0. 001; APACHE Ⅱ score: [9 (0 ～ 37 )] vs [11 (3 ～ 38 )], P = 0. 001 ). Nine cases died in SVAs patients ( 12. 5% ) and 19 died in the non-SVAs patients (3.9%), with significant difference between the two groups( x2 = 9. 673, P = 0. 002). Conclusion In oncologic surgical ICU, the incidence of SVAs is high. Age,history of coronary heart diseases, sepsis and intra-thoracic procedure were independent rsik factors of SVAs. SVAs prolong ICU length of stay. SVAs is a marker of critical illness severity.