老年贲门癌术后心律失常的危险因素分析

目的探讨老年患者贲门癌根治术后早期心律失常的危险因素。方法将上海复旦大学附属华东医院胸外科、普外科1999至2009年收治的老年贲门癌术后早期发生心律失常的63例患者的资料，与按1：2比例随机抽取同期老年贲门癌根治术后未发生心律失常的126例患者的资料作对照，进行单因素分析和多因素Logistic回归分析。结果单因素分析结果显示：是否经胸手术、术后PaO2/FiO2、术后PaO2、术后低钾血症、吸烟史、术前EKG显示心肌缺血、术前血黏度增高、术后止痛不佳与老年贲门癌术后发生心律失常有关。多因素Logistic回归分析显示：术后PaO2／FiO2〈300mmHg、术后低钾血症、经胸手术、术前EKG显示心肌缺血为老年贲门癌术后发生心律失常的危险劂素。结论临床上可根据术后PaO2/FiO2〈300mmHg、术后低钾血症、经胸手术、术前EKG显示心肌缺血预测术后心律失常，指导采取预防措施，以减少心律失常的发生。

Analysis of the risky factors for postoperative arrhythmia in elder cardiac carcinoma patients

Objective To analyze the risky factors associated with postoperative arrhythmia in elder cardiac carcinoma patients. Methods Between 1999 and 2009, 189 elder patients undergoing resection of cardiac carcinoma were reviewed retrospectively according to presence or absence of arrhythmia. Multiple preoperative factors were evaluated by univariate and multivariate logistic regression analysis. Results Univariate risk factors included postoperative hypoxemia （P〈0.05）, postoperative hypokalemia （P〈0.01）, preoperative blood viscosity lever increase （P〈 0.05）, incision at chest （P〈 0.05）, myocardial ischemia （P〈0.05）, taken epidural analgesia after operation （P〈0.05）, low ratio of arterial oxygen tension to inspired oxygen fraction （PaO2/FiO2） （P〈0.01）, smoking （P〈0.05）. Multivariate logistic regression analysis identified that low ratio of arterial oxygen tension to inspired oxygen fraction （PaOJFiO2）, postoperative hypokalemia, in- cision at chest, myocardial ischemia were risk factors. Conclusion These results suggest that the patients with risk factors described above need more careful peri- and post- operative surveillance and management.