O'Kelly B, Browner W S, Massie B, Tubau J, Ngo L, Mangano D T
Department of Medicine, University of California, San Francisco.
JAMA. 1992 Jul 8;268(2):217-21. doi: 10.1001/jama.268.2.217.
To determine the incidence, clinical predictors and prognostic importance of perioperative ventricular arrhythmias.
Prospective cohort study (Study of Perioperative Ischemia).
University-affiliated Department of Veterans Affairs Medical Center, San Francisco, Calif.
A consecutive sample of 230 male patients, with known coronary artery disease (46%) or at high risk of coronary artery disease (54%), undergoing major noncardiac surgical procedures.
We recorded cardiac rhythm throughout the preoperative (mean = 21 hours), intraoperative (mean = 6 hours), and postoperative (mean = 38 hours) periods using continuous ambulatory electrocardiographic monitoring. Adverse cardiac outcomes were noted by physicians blinded to information about arrhythmias.
Frequent or major ventricular arrhythmias (greater than 30 ventricular ectopic beats per hour, ventricular tachycardia) occurred in 44% of our patients: 21% preoperatively, 16% intraoperatively, and 36% postoperatively. Compared with the preoperative baseline, the severity of arrhythmia increased in only 2% of patients intraoperatively but in 10% postoperatively. Preoperative ventricular arrhythmias were more common in smokers (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.2 to 15.0), those with a history of congestive heart failure (OR, 4.1; 95% CI, 1.9 to 9.0), and those with electrocardiographic evidence of myocardial ischemia (OR, 2.2; 95% CI, 1.1 to 4.7). Preoperative arrhythmias were associated with the occurrence of intraoperative and postoperative arrhythmias (OR, 7.3; 95% CI, 3.3 to 16.0, and OR, 6.4; 95% CI, 2.7 to 15.0, respectively). Nonfatal myocardial infarction or cardiac death occurred in nine men; these outcomes were not significantly more frequent in those with prior perioperative arrhythmias, albeit with wide CIs (OR, 1.6; 95% CI, 0.4 to 6.2).
Almost half of all high-risk patients undergoing noncardiac surgery have frequent ventricular ectopic beats or nonsustained ventricular tachycardia. Our results suggest that these arrhythmias, when they occur without other signs or symptoms of myocardial infarction, may not require aggressive monitoring or treatment during the perioperative period.
确定围手术期室性心律失常的发生率、临床预测因素及预后重要性。
前瞻性队列研究（围手术期缺血研究）。
加利福尼亚州旧金山市退伍军人事务医疗中心大学附属科室。
连续抽取的230例男性患者，已知患有冠状动脉疾病（46%）或有冠状动脉疾病高风险（54%），接受重大非心脏手术。
我们在术前（平均21小时）、术中（平均6小时）和术后（平均38小时）全程使用动态心电图监测记录心律。心律失常相关信息对医生保密，由医生记录不良心脏结局。
44%的患者发生频繁或严重室性心律失常（每小时室性早搏大于30次、室性心动过速）：术前21%，术中16%，术后36%。与术前基线相比，术中仅有2%的患者心律失常严重程度增加，术后则为10%。术前室性心律失常在吸烟者中更常见（比值比[OR]，4.1；95%置信区间[CI]，1.2至15.0）、有充血性心力衰竭病史者中更常见（OR，4.1；95%CI，1.9至9.0）以及有心肌缺血心电图证据者中更常见（OR，2.2；95%CI，1.1至4.7）。术前心律失常与术中及术后心律失常的发生相关（分别为OR，7.3；95%CI，3.3至16.0，以及OR，6.4；95%CI，2.7至15.0）。9名男性发生非致命性心肌梗死或心源性死亡；这些结局在有围手术期心律失常病史者中虽不显著更常见，但置信区间较宽（OR，1.6；95%CI，0.4至6.2）。
几乎一半接受非心脏手术的高危患者有频繁室性早搏或非持续性室性心动过速。我们的结果表明，这些心律失常在无其他心肌梗死体征或症状时，围手术期可能无需积极监测或治疗。
