Sekine Y, Kesler K A, Behnia M, Brooks-Brunn J, Sekine E, Brown J W
Department of Surgery, Indiana University Medical Center, Indianapolis, IN 46202, USA.
Chest. 2001 Dec;120(6):1783-90. doi: 10.1378/chest.120.6.1783.
This study investigated the association of COPD and postoperative cardiac arrhythmias, specifically supraventricular tachycardia (SVT), as well as mortality in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC).
A retrospective chart review of 244 patients who had undergone lung resection for NSCLC at Indiana University Hospital between 1992 and 1997 was undertaken. COPD, which was defined as an FEV(1) of < or = 70% predicted and an FEV(1)/FVC ratio of < or = 70% based on the results of a preoperative pulmonary function test (PFT), was diagnosed in 78 of the 244 patients (COPD group). In the remaining 166 patients, the results of preoperative PFTs did not meet these criteria (non-COPD group). Both groups were otherwise well-matched with respect to multiple variables, including age, comorbid conditions, extent of pulmonary resection, and final pathologic stage. The incidence of cardiac arrhythmias and operative mortality were compared between the two groups using univariate and multivariate analysis.
Seventy-six patients (31.9%) experienced new onsets of postoperative SVT, with 58 of these patients (76.3%) demonstrating atrial fibrillation. The COPD group had a 58.7% incidence of SVT (n = 44) compared to a 27.0% incidence (n = 44) in the non-COPD group (p < 0.0 0 1). Moreover, following initial digoxin therapy, the COPD group required more second-line antiarrhythmic therapy than did the non-COPD group (66.7% vs 37.8%, respectively; p = 0.0 03). Overall, there were 16 operative deaths (6.6%), and the mortality rate was significantly higher in the COPD group (14.1%) than in the non-COPD group (3.0%; p = 0.0 04). Patients who developed SVT had a significantly longer hospital course than did patients who did not (p < 0.0001). Thirteen of the 16 patients who died experienced SVT; however, SVT was not an independent risk factor for death. Finally, of the 19 variables evaluated, major resection (ie, pneumonectomy and bilobectomy) and COPD were identified as independent risk factors for the development of cardiac arrhythmias (p = 0.0 033 and p = 0.0 009, respectively).
Patients with COPD, as defined by the results of preoperative PFTs, are at significantly higher risk for SVT, and in particular SVT refractory to digoxin, following pulmonary resection for NSCLC. Although SVT was not an independent risk factor for death, a significantly longer hospitalization was observed.
本研究调查慢性阻塞性肺疾病（COPD）与非小细胞肺癌（NSCLC）肺切除术后心律失常（特别是室上性心动过速（SVT））以及死亡率之间的关联。
对1992年至1997年间在印第安纳大学医院接受NSCLC肺切除术的244例患者进行回顾性病历审查。根据术前肺功能测试（PFT）结果，将FEV(1)≤预测值的70%且FEV(1)/FVC比值≤70%定义为COPD，244例患者中有78例被诊断为COPD（COPD组）。其余166例患者术前PFT结果未达到这些标准（非COPD组）。两组在年龄、合并症、肺切除范围和最终病理分期等多个变量方面匹配良好。使用单因素和多因素分析比较两组心律失常的发生率和手术死亡率。
76例患者（31.9%）术后出现新发SVT，其中58例（76.3%）表现为房颤。COPD组SVT发生率为58.7%（n = 44），而非COPD组为27.0%（n = 44）（p < 0.001）。此外，在初始地高辛治疗后，COPD组比非COPD组需要更多的二线抗心律失常治疗（分别为66.7%和37.8%；p = 0.003）。总体而言，有16例手术死亡（6.6%），COPD组的死亡率（14.1%）显著高于非COPD组（3.0%；p = 0.004）。发生SVT的患者住院时间明显长于未发生SVT的患者（p < 0.0001）。16例死亡患者中有13例发生了SVT；然而，SVT不是死亡的独立危险因素。最后，在评估的19个变量中，大手术切除（即全肺切除术和肺叶切除术）和COPD被确定为心律失常发生的独立危险因素（分别为p = 0.0033和p = 0.0009）。
根据术前PFT结果定义的COPD患者，在NSCLC肺切除术后发生SVT的风险显著更高，尤其是对地高辛难治的SVT。虽然SVT不是死亡的独立危险因素，但观察到住院时间明显延长。
