Levine P A, Klein M D
Geriatrics. 1976 Nov;31(11):47-56.
Because of the close anatomic and physiologic relationship between the heart and lungs, patients with chronic obstructive lung disease are at special risk of arrhythmias. Effective therapy hinges on identifying the mechanisms of the arrhythmias--hemodynamic, metabolic, or drug-induced. Impulsive use of antiarrhythmic agents may result only in a more complex and dangerous rhythm disorder. Extremes of pH are a major cause of arrhythmias in these patients. Respiratory alkalemia usually originates with inappropriate ventilation, often during mechanical respiration, while metabolic alkalemia generally can be traced to diuretic or bicarbonate therapy. Lidocaine or diphenylhydantoin are of little use, since the alkaline pH inside and outside heart muscle cells hampers drug distribution and activity. At the other extreme, the arrhythmias of acidemia strike patients who have severe respiratory failure with carbon dioxide retention or severe cardiac failure with shock and lactic acidemia. Arrhythmias may develop if vagal restraint is lost, which is especially likely in patients with potassium depletion. Irritant receptors along the bronchopulmonary tree can trigger arrhythmias if stimulated by cough, microembolism, or mechanical irritation, which is a hazard with endotracheal or tracheostomy tubes.
由于心脏与肺之间存在密切的解剖和生理关系，慢性阻塞性肺疾病患者特别容易发生心律失常。有效的治疗取决于确定心律失常的机制——血流动力学、代谢或药物诱导。盲目使用抗心律失常药物可能只会导致更复杂、更危险的节律紊乱。pH值异常是这些患者心律失常的主要原因。呼吸性碱血症通常源于通气不当，常在机械通气期间出现，而代谢性碱血症一般可追溯到利尿剂或碳酸氢盐治疗。利多卡因或苯妥英钠用处不大，因为心肌细胞内外的碱性pH值会妨碍药物分布和活性。在另一个极端情况下，酸血症性心律失常发生在患有严重呼吸衰竭伴二氧化碳潴留或严重心力衰竭伴休克和乳酸血症的患者身上。如果迷走神经抑制作用丧失，就可能会出现心律失常，低钾血症患者尤其容易出现这种情况。如果支气管肺树的刺激感受器受到咳嗽、微栓塞或机械刺激（这是气管内插管或气管切开术插管的一种风险）的刺激，就可能引发心律失常。
