老年心血管病患者白内障围手术期心律失常的变化及对策

目的应用动态心电图（DCG）观察老年心血管病患者行白内障摘除术围手术期心律失常发生情况，为制定干预措施提供依据。方法对66例（72只眼）年龄／〉60岁伴有心血管病史的白内障手术摘除患者，在围手术期间进行24hDCG监测，观察术前2h、术中以及术后2h的心律失常变化，所得DCG数据用统计学方法进行对比分析研究。结果66例患者在围手术期间心律失常的总发生率为87．9％，以房性心律失常最高（86．2％），室性心律失常次之（72．4％）；短暂房性心动过速和短暂室性心动过速分别为24．1％和3．4％。术中和术后2h房性心律失常发生率明显高于术前2h（P=0．000）；而术中和术后2h室性心律失常明显低于术前2h（P=0．000）。23例（34．8％）有眼心反射的发生。术后出院视力脱残率为86．1％，脱盲率为93．1％。手术中无严重全身并发症发生。结论老年心血管病患者白内障围手术期心律失常发生率较高，术前应予全面综合分析和评估，针对其变化特点采取相应措施，尽可能减少心律失常的发生，使手术风险降至最低。

Change and countermeasures of arrhythmia in elderly patients with cardiovascular disease in perioperative period of catarcut surgery

Objective To observe the changes of arrhythmia in elderly patients with cardiovascular disease in perioperative period of cataract surgery with dynamic electrocardiogram （ DCG）, providing the basis for the devel- opment of interventions. Methods Sixty-six patients （72 eyes） with cardiovascular disease aged over 60 years under- going cataract surgery were observed with DCG in the perioperative period. The DCG data at 2 h before operation, dur- ing operation, and at 2 h after operation were comparatively analyzed using statistical methods. Results In the periop- erative period, the incidence of arrhythmias was 87.9%, atrial arrhythmia 86. 2%, ventricular arrhythmia followed by 72. 4%. Short-term atrial tachycardia and transient ventricular tachyeardia were 24. 1% and 3.4% respectively. The incidence of the atrial arrhythmia was higher and the incidence of ventricular arrhythmia was lower at 2 h before operation compared with those during operation and at 2 h after operation （ all P = 0. 000 ） In addition, the oculocardi- ac reflex occurred in 23 patients （34. 8% ） during surgery. The off-remnant rate was 86. 1% and The off-blindness rate 93.1% when patients were discharged from hospital. There were not serious systemic complications in surgery. Conclusion The incidence of arrhythmia in elderly patients with cardiovascular disease in perioperative period of cataract surgery is higher. Strengthening the comprehensive analysis and evaluation before operation, taking measures to reduce the occurrence of arrhythmia in view of the change characteristics and minimizing surgery risk, which can improve the prognosis of cataract surgery in elderly patients with cardiovascular disease.