CAJ | 학술논문

目的探讨支气管肺泡灌洗术对重度肺炎患儿心脏节律及传导的影响.方法 2011年7月至2012年3月,选择在大连市儿童医院呼吸科住院并符合纳入标准及适应证的30例重度肺炎患儿,其中男17例、女13例,平均年龄5.3岁.采用连续采样的方法,在支气管肺泡灌洗术前、麻醉、入声门、注液、吸引、苏醒环节进行心电图检查,并测量心电图中心率、节律、P波振幅及宽度、PR间期、QRS波形态及宽度,对所记录数据进行统计学分析.结果 30例患儿行支气管肺泡灌洗术整个操作过程中除P波外,其余心电图指标均出现异常.30例患儿均出现心率增快,26例(86.7％)患儿从麻醉开始后即开始明显增快,4例在气管镜操作开始后也出现,均为窦性心动过速,以注液及苏醒时最明显[(155±15)和(155±19)次/min].13例(43.3％)患儿在入声门、注液、吸引环节中出现除窦性心动过速以外的心律失常(窦性心动过缓、房室传导阻滞、早搏).术中心律失常发生率与术前、术后相比较,差异均有统计学意义(P=0.00).对出现心律失常的环节之间进行比较,差异均无统计学意义(P=0.83).心律失常以早搏最多见(17例次),其中9例房性早搏,8例室性早搏,两组差异无统计学意义(P=0.77).心律失常组低氧血症伴随比例与未发生心律失常组差异有统计学意义(12/21比4/17,x2=4.35,P=0.04).入声门过程中有2例患者发生Ⅲ度房室传导阻滞伴有明显窦性心动过缓,经及时处理后恢复.操作结束进入苏醒环节后心律失常均恢复正常.5例(16.7％)患儿在各环节出现PR间期延长,其中3例患儿在≥2个环节均有PR间期延长,1例患儿直至麻醉苏醒PR间期仍未恢复正常,术中与术前及术后相比较差异均无统计学意义[13.3％(4例)比0(0例)和3.3％(1例),均P＞0.05].对出现PR间期异常的各个环节进行比较,PR间期异常率差异无统计学意义(P=0.81).5例(16.7％)患儿QRS波可见不完全性右束支传导阻滞(IRBBB)现象,其中4例(13.3％)患儿在≥2个环节均发生IRBBB现象,术中与术前及术后差异均无统计学意义[13.3％(4例)比0(0例)和3.3％(1例),均P＞0.05].对出现IRBBB现象的各个环节进行比较,发生率差异无统计学意义(P=0.82).不同环节对除心率以外的心电图各个测量值的影响差异均无统计学意义(均P ＞0.05).结论支气管肺泡灌洗术对心脏电生理存在影响,但影响不大,持续时间不长;从心电生理角度来看,支气管肺泡灌洗术的安全性可以得到保证. 目的探討支氣管肺泡灌洗術對重度肺炎患兒心髒節律及傳導的影響.方法 2011年7月至2012年3月,選擇在大連市兒童醫院呼吸科住院併符閤納入標準及適應證的30例重度肺炎患兒,其中男17例、女13例,平均年齡5.3歲.採用連續採樣的方法,在支氣管肺泡灌洗術前、痳醉、入聲門、註液、吸引、囌醒環節進行心電圖檢查,併測量心電圖中心率、節律、P波振幅及寬度、PR間期、QRS波形態及寬度,對所記錄數據進行統計學分析.結果 30例患兒行支氣管肺泡灌洗術整箇操作過程中除P波外,其餘心電圖指標均齣現異常.30例患兒均齣現心率增快,26例(86.7％)患兒從痳醉開始後即開始明顯增快,4例在氣管鏡操作開始後也齣現,均為竇性心動過速,以註液及囌醒時最明顯[(155±15)和(155±19)次/min].13例(43.3％)患兒在入聲門、註液、吸引環節中齣現除竇性心動過速以外的心律失常(竇性心動過緩、房室傳導阻滯、早搏).術中心律失常髮生率與術前、術後相比較,差異均有統計學意義(P=0.00).對齣現心律失常的環節之間進行比較,差異均無統計學意義(P=0.83).心律失常以早搏最多見(17例次),其中9例房性早搏,8例室性早搏,兩組差異無統計學意義(P=0.77).心律失常組低氧血癥伴隨比例與未髮生心律失常組差異有統計學意義(12/21比4/17,x2=4.35,P=0.04).入聲門過程中有2例患者髮生Ⅲ度房室傳導阻滯伴有明顯竇性心動過緩,經及時處理後恢複.操作結束進入囌醒環節後心律失常均恢複正常.5例(16.7％)患兒在各環節齣現PR間期延長,其中3例患兒在≥2箇環節均有PR間期延長,1例患兒直至痳醉囌醒PR間期仍未恢複正常,術中與術前及術後相比較差異均無統計學意義[13.3％(4例)比0(0例)和3.3％(1例),均P＞0.05].對齣現PR間期異常的各箇環節進行比較,PR間期異常率差異無統計學意義(P=0.81).5例(16.7％)患兒QRS波可見不完全性右束支傳導阻滯(IRBBB)現象,其中4例(13.3％)患兒在≥2箇環節均髮生IRBBB現象,術中與術前及術後差異均無統計學意義[13.3％(4例)比0(0例)和3.3％(1例),均P＞0.05].對齣現IRBBB現象的各箇環節進行比較,髮生率差異無統計學意義(P=0.82).不同環節對除心率以外的心電圖各箇測量值的影響差異均無統計學意義(均P ＞0.05).結論支氣管肺泡灌洗術對心髒電生理存在影響,但影響不大,持續時間不長;從心電生理角度來看,支氣管肺泡灌洗術的安全性可以得到保證.
목적 탐토지기관폐포관세술대중도폐염환인심장절률급전도적영향.방법 2011년7월지2012년3월,선택재대련시인동의원호흡과주원병부합납입표준급괄응증적30례중도폐염환인,기중남17례、녀13례,평균년령5.3세.채용련속채양적방법,재지기관폐포관세술전、마취、입성문、주액、흡인、소성배절진행심전도검사,병측량심전도중심솔、절률、P파진폭급관도、PR간기、QRS파형태급관도,대소기록수거진행통계학분석.결과 30례환인행지기관폐포관세술정개조작과정중제P파외,기여심전도지표균출현이상.30례환인균출현심솔증쾌,26례(86.7％)환인종마취개시후즉개시명현증쾌,4례재기관경조작개시후야출현,균위두성심동과속,이주액급소성시최명현[(155±15)화(155±19)차/min].13례(43.3％)환인재입성문、주액、흡인배절중출현제두성심동과속이외적심률실상(두성심동과완、방실전도조체、조박).술중심률실상발생솔여술전、술후상비교,차이균유통계학의의(P=0.00).대출현심률실상적배절지간진행비교,차이균무통계학의의(P=0.83).심률실상이조박최다견(17례차),기중9례방성조박,8례실성조박,량조차이무통계학의의(P=0.77).심률실상조저양혈증반수비례여미발생심률실상조차이유통계학의의(12/21비4/17,x2=4.35,P=0.04).입성문과정중유2례환자발생Ⅲ도방실전도조체반유명현두성심동과완,경급시처리후회복.조작결속진입소성배절후심률실상균회복정상.5례(16.7％)환인재각배절출현PR간기연장,기중3례환인재≥2개배절균유PR간기연장,1례환인직지마취소성PR간기잉미회복정상,술중여술전급술후상비교차이균무통계학의의[13.3％(4례)비0(0례)화3.3％(1례),균P＞0.05].대출현PR간기이상적각개배절진행비교,PR간기이상솔차이무통계학의의(P=0.81).5례(16.7％)환인QRS파가견불완전성우속지전도조체(IRBBB)현상,기중4례(13.3％)환인재≥2개배절균발생IRBBB현상,술중여술전급술후차이균무통계학의의[13.3％(4례)비0(0례)화3.3％(1례),균P＞0.05].대출현IRBBB현상적각개배절진행비교,발생솔차이무통계학의의(P=0.82).불동배절대제심솔이외적심전도각개측량치적영향차이균무통계학의의(균P ＞0.05).결론 지기관폐포관세술대심장전생리존재영향,단영향불대,지속시간불장;종심전생리각도래간,지기관폐포관세술적안전성가이득도보증.
Objective To observe the effect of bronchoalveolar lavage on the heart rhythm and conduction of children with severe pneumonia through monitoring the electrocardiogram change of different step of the bronchoalveolar lavage,for proving the safety of the operation of bronchoalveolar lavage from the perspective of cardiac electrophysiology.Method From July 2011 to March 2012,30 patients who were hospitalized in pneumology department of Dalian Children's Hospital and met the inclusion criteria and therapeutic indications of bronchoalveolar lavage were chosen.They were 3 to 12 years old,the average age was 5.3 years,including 17 boys and 13 girls,the ratio of boys and girls is 1.3∶ 1.Continuous sampling the electrocardiogram before and duriug the process including anesthesia,entering into glottis,lavage,aspiration,and revive,and recording the heart rate,rhythm amplitude and width of P wave,the PR interval,the form and width of QRS complex were also measured.The recorded data were analyzed and statistical analysis to reflect the change of the cardiac electrophysiology.Result The incidence of heart rate increase was 100.0％,26 (86.7％) patients began to emerge after anesthesia,the rest of the patients also developed heart rate increase after the start of bronchoscopic operation.All patients had sinus tachycardia,and were most obvious in the progress of lavage and revive.In the process of entering into glottis,lavage,aspiration,13 (43.3％)patients had arrhythmia episodes.Types of arrhythmia included sinus bradycardia,atrioventricular block and premature beat.Incidences of intraoperative arrhythmia compared with the preand post-operation were all statistically significantly different (P =0.00).The most common arrhythmia were premature beat,in 17 of the 30 cases there were premature beat including 9 cases with atrial premature beats and 8 cases ventricular premature contraction.Two patients had Ⅲ ° atrioventricular block accompanied by serious sinus bradycardia.All kinds of arrhythmias except sinus tachycardia disappeared after the operation was ended.Five patients (16.7％) had PR interval prolongation.Five patients (16.7％) had incomplete right bundle branch block(IRBBB).Incidences of IRBBB compared with the pre-operation and post-operation were all not significantly different [13.3％ (n =4) vs.0(n =0) and 3.3％ (n =1),all P ＞ 0.05].Different operating progress made no significant difference in the measurement value of electrocardiogram[13.3％ (n =4) vs.0(n =0) and 3.3％ (n =1),all P ＞ 0.05],but showed the most notable effect on heart rate.Conclusion Bronchoalveolar lavage can influence the heart rhythm and conduction,but most of the influence with pathological significance are transient.Cardiac electrophysiological changes were the most obvious in endotracheal operation with the risk of malignant arrhythmia but the risk is low,the bronchoalveolar lavage technique is safe.The contingency plans for dealing with all kinds of adverse reactions must be ready before the operations of bronchoalveolar lavage.During the procedure,the patient's ECG changes should be closely monitored to reduce the incidence of adverse reactions.