内科胸腔镜术中心脏并发症危险因素分析

目的研究局麻下内科胸腔镜术中心脏并发症危险因素,并探讨相应对策。方法对2000—2004年于山东省立医院呼吸科住院接受开放式胸腔镜术15例患者,监测术前、术中血压、心率、动脉血气指标、脉搏氧饱和度(SpO2)、心电图(ECG)及非术侧卧位肺功能,Logistic回归分析心脏并发症危险因素。结果(1)15例患者中有10例术中出现一过性ECG变化:术中S-T段较术前升高或降低≥0.1 mV和(或)出现室性早搏≥5个/m in,皆呈一过性,其中9例发生于术中前30 m in内。(2)发生ECG变化者术前及术中心率、血压、心肌耗氧指数(收缩压×心率)、SpO2、动脉血气指标与未发生者比较差异无统计学意义(P>0.05)。(3)术中胸腔内吸引及疼痛与心脏并发症的发生无相关性(P>0.05),不是心脏并发症的危险因素(P>0.05)。(4)发生心脏并发症者术中非术侧卧位肺活量(VC)、VC占预计值百分比、第一秒用力呼气容积(FEV1)比未发生者明显减少,差异有统计学意义(P<0.05);心脏并发症的发生与术中VC<1.0 L、FEV1<0.5 L高度相关(P<0.05)。结论(1)内科胸腔镜术中ECG变化多为一过性,但对于心肺功能差者应提高警惕;(2)术中疼痛和胸腔内吸引不是内科胸腔镜术中心脏并发症危险因素;(3)内科胸腔镜术中心脏并发症的发生与患者术中肺功能减低有关,术中VC<1.0 L、FEV1<0.5 L时心脏并发症可能增加。

Analysis of risk factors for cardiac complications during medical thoracoscopy

Objective To study the risk factors for cardiac complications in open thoracoscopy under local anesthesia and consider the countermeasures.Methods From 2000 to 2004 in fifteen patients,blood pressure,respiratory frequency,cardiac rhythm and frequency,ECG,SpO2,and arterial blood gas(ABG)were prospectively measured before,during,and after the thoracoscopy.Results(1)In ten patients cardiac complications,transient myocardial ischemia and/or ventricular premature beat were found.(2)There were no significant variation in blood pressure,respiratory frequency,cardiac rhythm and frequency,myocardial oxygen consumption index,SpO2,and arterial blood gas(ABG)between the patients who had the cardiac complications during the operation procedure and those who had no complications(P>0.05).(3)The pain and aspiration during the operation were found to have no significant correlation with the ECG variation(P>0.05)and were not the risk factors for the ECG variation(P>0.05).(4)The para-operation pulmonary function indexes(VC,VC%,FEV1)of the patients who had the variation of ECG were significantly lower than those of no-complication patients.(P<0.05).The cardiac incidence had significant correlation with para-operation VC<1.0 L,FEV1<0.5 L.Conclusion(1)The variation of ECG during the medical thoracoscopy procedure is transient,but more attention should be paid to some cases.(2)The pain and aspiration during the operation are not the risk factors for the ECG variation.(3)The cardiac incidences are associated with the decline of pulmonary function during the procedure.The cardiac complication might increase when VC<1.0 L,FEV1<0.5 L in the operation.