Ciriaco P, Mazzone P, Canneto B, Zannini P
Division of Thoracic Surgery, University of Milan, Scientific Institute H.S. Raffaele, Via Olgettina 60, 20132, Milan, Italy.
Eur J Cardiothorac Surg. 2000 Jul;18(1):12-6. doi: 10.1016/s1010-7940(00)00428-0.
From January 1998 to February 1999, 160 patients undergoing lung resection for non-small cell lung cancer were studied to define factors that increase the risk of postoperative supraventricular arrhythmia (SA) and to assess the effectiveness of amiodarone as an antiarrhythmic drug.
All patients were monitored intraoperatively and postoperatively up to day 3. Onset of SA was documented with ECG. Amiodarone was administered to those who developed SA with a loading dose of 5 mg/kg in 30 min and a maintenance dose of 15 mg/kg in 24 h.
Mean age was 64 years (range 27-83 years). There were nine wedge resections, six segmentectomies, 127 lobectomies and 18 pneumonectomies. Twenty-two patients (13%) had SA, all of which were atrial fibrillations. The incidence of supraventricular arrhythmia with pneumonectomy and lobectomy was 33 and 12%, respectively (P=0.02). None of the patients who had a minor resection developed SA. The peak incidence of onset of SA occurred on postoperative day 2 and lasted from 1 to 12 days (average 3.4 days). Sinus rhythm was achieved with amiodarone in 20 patients (90.9%) with no side effects. Two patients received electrical cardioversion because hemodynamically unstable. Mean preoperative pO(2) and pCO(2) were lower in patients with SA: pO(2) 80.8 vs. 85 mmHg (P=0.04); pCO(2) 35.5 vs. 38 mmHg (P=0.01). Patients with concomitant cardiopulmonary diseases presented an odds ratio for postoperative arrhythmia of 12.4 (confidence interval 4. 5-34.1) (P<0.0001).
Concomitant cardiopulmonary diseases, lower pO(2), pCO(2) and extent of surgery increase the risk of postoperative SA after lung resection for non-small cell lung cancer. Cardiac monitoring in patients at risk is recommended. Amiodarone was both safe and effective in establishing and maintaining sinus rhythm.
对1998年1月至1999年2月期间160例行非小细胞肺癌肺切除术的患者进行研究，以确定增加术后室上性心律失常（SA）风险的因素，并评估胺碘酮作为抗心律失常药物的有效性。
所有患者在术中及术后3天内均接受监测。SA的发作通过心电图记录。对发生SA的患者给予胺碘酮，负荷剂量为5mg/kg，30分钟内静脉推注，维持剂量为15mg/kg，24小时内静脉滴注。
患者平均年龄64岁（范围27 - 83岁）。其中9例行楔形切除术，6例行肺段切除术，127例行肺叶切除术，18例行全肺切除术。22例患者（13%）发生SA，均为房颤。全肺切除术和肺叶切除术后室上性心律失常的发生率分别为33%和12%（P = 0.02）。行小范围切除术的患者均未发生SA。SA发作的高峰出现在术后第2天，持续1至12天（平均3.4天）。20例患者（90.9%）使用胺碘酮后恢复窦性心律，且无副作用。2例患者因血流动力学不稳定接受了电复律。发生SA的患者术前平均pO₂和pCO₂较低：pO₂分别为80.8mmHg和85mmHg（P = 0.04）；pCO₂分别为35.5mmHg和38mmHg（P = 0.01）。合并心肺疾病的患者术后心律失常的比值比为12.4（置信区间4.5 - 34.1）（P < 0.0001）。
合并心肺疾病、较低的pO₂、pCO₂以及手术范围增加了非小细胞肺癌肺切除术后SA的风险。建议对有风险的患者进行心脏监测。胺碘酮在建立和维持窦性心律方面安全有效。
