胸部手术后的多系统并发症

目的：探讨胸部手术后发生多系统并发症(如心律失常、高血压、高血糖、应激性胃出血)的危险因素，提出相应的预防措施。方法：回顾：1996年～2001年我科完成的1：103例胸部手术，其中肺手术714例、食管手术282例、纵隔手术107例。术前所有患者心电图、血压、血糖结果均达到手术标准，无消化道溃疡病史及症状。术后常规监测记录心律失常、高血压、高血糖及应激性消化道出血的发生及缓解情况。结果：本组心律失常、高血压、高血糖、应激性胃出血的发生率为7．98％、3．72％、0．73％和0．27％，多数患者经治疗在术后3～7d内缓解。肺手术，特别是全肺切除和切除心包、心包内阻断和／或结扎肺血管患者术后心律失常发生率明显增高。年龄、术前心电图异常是心律失常的相关危险因素。有糖尿病史者术后高血糖发生率显著增加。应激性胃出血见于食管手术后患者。结论：手术方式、年龄、术前基础病变均为相关危险因素。积极治疗，疗效良好。

Multi systemic complications after thoracotomy

Objective:To review different kinds of thoracotomy including lung,esophagus and mediastinum done in our department from 1996 to 2001. Mayor operative multi systemic complications including arrhythmias,hypertension,hyperglycemia and excitable gastric mucosa bleeding were analyzed. The risk factors and prevention of these common complications were also analyzed. Methods:During this period,1103 cases of thoracotomy were done in our department,including 714 cases of lung,282 cases of esophagus and 107 cases of mediastinum. Before operation,regular examinations and preparations were done routinely. The results of ECG,blood pressure and level of blood sugar of all patients matched operative standard. No patient had medical history or symptom of ulcer of digestive tract. After operation,vital data were monitored once again. Occurrence time and degree; treatment and remission of these complications were recorded. Statistical analysis was used for treating results. Results: The incidences of arrhythmia,hypertension,hyperglycemia and excitable gastric mucosa bleeding were 7.98%,3.72%,0.73% and 0.27%,respectively. Mortality was 0. The incidence of arrhythmia was the highest,which followed by the incidence of hypertension. These two incidences were higher than that of others two groups significantly. Lung surgery,especially pneumonectomy and resection of pericardium or interruption and/or ligation of pulmonary vassals in pericardium could cause high incidence of arrhythmia. Age and abnormality of pre-operative ECG were risk factors of arrhythmia too. Hypertension also had close relation to age and pre-operative history of hypertension. Patients with diabetes were easier to have hyperglycemia after operation. Excitable gastric mucosa bleeding only occurred in patients with operation of esophagus in our group. After treatment,major multi systemic complications were remitted in 3-7 days. Conclusion: Method of operation,age,related disease were risk factors. Effective treatment could be of good results.