QT间期延长与肝移植术后近期心律失常的关系

目的总结和探讨肝移植术前心电图提示QT间期延长与肝移植术后近期各类心律失常的关系。方法回顾性分析北京佑安医院2004年6月～2012年1月500例肝移植患者术前心电图的QT间期与术后近期（术后2周内）各种心律失常的发生率及其诊治资料。结果在500例肝移植患者中有82例（16.4％）发生各类心律失常，其中，病态窦房结综合征（包括持续而显著的窦性心动过缓）35例（7．0％），阵发性室上性心动过速18例（3．6％），心房颤动21例（4．2％），室性心动过速8例（1．6％，包括2例尖端扭转性室性心动过速）；82例心律失常患者中心脏骤停4例（0．8％），由心律失常引起的死亡2例（0．4％）。根据术前心电图检查结果，将患者分为QT间期延长组共103例，QT间期正常组共397例，其中，QT间期延长组中有28例患者发生心律失常，QT间期正常组中有54例患者发生心律失常，肝移植术后近期心律失常的发生与QT间期延长有明显关系（x^2=11．00，P〈0．01）。结论心律失常是肝移植术后常见的并发症．甚至可导致死亡。术前心电图QT间期延长与肝移植术后近期心律失常的发生有明显关系。因此，对于术前QT间期延长的患者应加强监测和评估，并给予预防性措施，如安置临时心脏起搏器，以防止术中及术后心血管意外的发生。

Relationship between QT interval prolongation and recent incidence of arrhythmia after liver transplantation

Objective To summarize and explore the relationship between electrocardiogram prompted QT prolongation before liver transplantation and various recent incidence of arrhythmia after liver transplantation.Methods The data of electrocardiogram QT interphase before liver transplantation and the recent incidence and treatment information of various arrhythmia after liver transplantation(2 weeks after surgery) among 500 cases of patients from June 2004 to January 2012 in Beijing You’an hospital were analyzed retrospectively.Results 82 cases(16.4%) of patients suffered with various types of arrhythmias in 500 cases of patients underwent liver transplantation,among whom sick sinus syndrome(including continuing and significant sinus bradycardia) in 35 cases(7.0%),paroxysmal supraventricular tachycardia in 18 cases(3.6%),atrial fibrillation in 21 cases(4.2%),ventricular tachycardia in 8 cases(1.6%,including 2 cases of torsades de pointes ventricular tachycardia).Among them,the occurrence of cardiac arrest were in 4 cases(0.8%),and 2 cases of death(0.4%) caused by arrhythmia.According to the results of the preoperative ECG,patients were divided into QT interval prolongation group with 103 cases and normal QT interval group with 397 cases.In QT interval prolongation group,28 patients had arrhythmia.In normal QT interval group,54 patients had arrhythmia.The recent incidence of arrhythmias after liver transplantation was related with QT prolongation(χ2 = 11.00,P < 0.01).Conclusion Arrhythmia is a common complication after liver transplantation,and it can even lead to death.QT interval prolongation before liver transplantation and the recent incidence of arrhythmia after liver transplantation is significantly related.Therefore,monitoring and evaluation should be strengthened for patients with preoperative QT prolongation,and prophylactic measures such as placement of temporary pacemakers should be given to prevent intraoperative and postoperative cardiovascular accidents.