Tagawa Tsutomu, Nakao K, Nakamura A, Yamasaki N, Tsuchiya T, Nagayasu T
Division of Surgical Oncology, Department of Translational Medical Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Kyobu Geka. 2008 Jul;61(8 Suppl):715-20.
After major noncardiac thoracic operations, various types of arrhythmia would occur. Particularly atrial fibrillation (Af), have remained one of the most frequent complications. In the literatures, risk factors for post operative Af have identified age, male, extent of pulmonary resection and mediastinal lymph node dissection. When we would meet the patients complicated with arrhythmia, the etiology of it must be identified and treated before operations. If accidental arrhythmia occurred during or after operations, the etiology of arrhythmia as hypoxia, hypercapnea, electrolyte disorder, overhydration and cardiac ischemia would be checked and cleared at first. Then appropriate drugs should be considered to use due to the type of arrhythmia. In supraventricular tachyarrhythmia, especially Af, landiolol and verapamil would be effective for the rate control and disopyramide and procaineamide for the defibrillation. Lidocaine and propranolol would be an appropriate choice for ventricular tachyarrhythmia during operations. For ventricular tachyarrhythmia related with acute myocardial infarction, lidocaine and mexiletine would be proper. In bradyarrhythmias a temporary pacing should be the first choice for urgent therapy. A prompt assessment and an adequate therapy must be mandatory for the arrhythmias after major noncardiac thoracic operations.
在非心脏大胸腔手术后，会出现各种类型的心律失常。特别是心房颤动（Af），一直是最常见的并发症之一。在文献中，已确定术后Af的危险因素有年龄、男性、肺切除范围和纵隔淋巴结清扫。当我们遇到合并心律失常的患者时，术前必须明确其病因并进行治疗。如果在手术期间或术后发生意外心律失常，首先要检查并排除心律失常的病因，如缺氧、高碳酸血症、电解质紊乱、补液过多和心脏缺血。然后根据心律失常的类型考虑使用适当的药物。在室上性快速心律失常，特别是Af中，兰地洛尔和维拉帕米对控制心率有效，丙吡胺和普鲁卡因胺对除颤有效。利多卡因和普萘洛尔是手术期间室性快速心律失常的合适选择。对于与急性心肌梗死相关的室性快速心律失常，利多卡因和美西律是合适的。在缓慢性心律失常中，临时起搏应作为紧急治疗的首选。对于非心脏大胸腔手术后的心律失常，必须进行及时评估和适当治疗。
