Hoffman Timothy M, Bush David M, Wernovsky Gil, Cohen Mitchell I, Wieand Tammy S, Gaynor J William, Spray Thomas L, Rhodes Larry A
Division of Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, Pennsylvania, USA.
Ann Thorac Surg. 2002 Nov;74(5):1607-11. doi: 10.1016/s0003-4975(02)04014-6.
Junctional ectopic tachycardia (JET) occurs commonly after pediatric cardiac operation. The cause of JET is thought to be the result of an injury to the conduction system during the procedure and may be perpetuated by hemodynamic disturbances or postoperative electrolyte disturbances, namely hypomagnesemia. The purpose of this study was to determine perioperative risk factors for the development of JET.
Telemetry for each patient admitted to the cardiac intensive care unit from December 1997 through November 1998 for postoperative cardiac surgical care was examined daily for postoperative JET. A nested case-cohort analysis of 33 patients who experienced JET from 594 consecutively monitored patients who underwent cardiac operation was performed. Univariate and multivariate analyses were conducted to determine factors associated with the occurrence of JET.
The age range of patients with JET was 1 day to 10.5 years (median, 1.8 months). Univariate analysis revealed that dopamine or milrinone use postoperatively, longer cardiopulmonary bypass times, and younger age were associated with JET. Multivariate modeling elicited that dopamine use postoperatively (odds ratio, 6.2; p = 0.01) and age less than 6 months (odds ratio, 4.0; p = 0.02) were associated with JET. Only 13 (39%) of the patients with JET received therapeutic interventions.
Junctional ectopic tachycardia occurred in 33 (5.6%) of 594 patients who underwent cardiac operation during the study period. Postoperative dopamine use and younger age were associated with JET. It may be speculated that dopamine should be discontinued in the presence of postoperative JET.
交界性异位性心动过速（JET）常见于小儿心脏手术后。JET的病因被认为是手术过程中传导系统受损的结果，并且可能因血流动力学紊乱或术后电解质紊乱（即低镁血症）而持续存在。本研究的目的是确定JET发生的围手术期危险因素。
对1997年12月至1998年11月入住心脏重症监护病房接受心脏术后护理的每位患者进行每日遥测，以检查术后是否发生JET。对594例连续接受心脏手术监测的患者中33例发生JET的患者进行巢式病例对照分析。进行单因素和多因素分析以确定与JET发生相关的因素。
发生JET的患者年龄范围为1天至10.5岁（中位数为1.8个月）。单因素分析显示，术后使用多巴胺或米力农、体外循环时间延长和年龄较小与JET相关。多因素模型显示，术后使用多巴胺（比值比，6.2；p = 0.01）和年龄小于6个月（比值比，4.0；p = 0.02）与JET相关。只有13例（39%）发生JET的患者接受了治疗干预。
在研究期间接受心脏手术的594例患者中，有33例（5.6%）发生了交界性异位性心动过速。术后使用多巴胺和年龄较小与JET相关。可以推测，术后发生JET时应停用多巴胺。
