Rose M R, Glassman E, Spencer F C
Am Heart J. 1975 Mar;89(3):288-94. doi: 10.1016/0002-8703(75)90077-0.
Arrhythmias were analyzed in 50 patients undergoing cardiac surgery: 27 with valve surgery, 15 with coronary artery bypass (CAB), 5 with CAB and valve surgery, and 3 with miscellaneous procedures. The role of electrolyte abnormalities, pericarditis, serum osmolarity, digoxin level, and the type of surgery performed was evaluated. Thirty-seven out of 50 patients (74 per cent) had a postoperative arrhythmia, and a total of 78 different arrhythmias were noted. Twenty-six out of 27 patients with valve surgery had an arrhythmia vs. six out of 15 patients with CAB (p less than 0.001). Atrial fibrillation was the most common arrhythmia in all groups. Although postoperative hypocalcemia, hypomagnesemia, pericarditis, and wide shifts in osmolarity were common, they did not correlate with arrhythmias. Seventeen patients developed postoperative arrhythmias compatible with digitalis toxicity, including junctional rhythm, atrioventricular dissociation, or atrial tachycardia with block. However, the range of serum digoxin levels in these patients was zero to 2.80 ng. per milliliter. This suggests increased sensitivity to digitalis glycosides or the effects of surgical trauma as the etiology of arrhythmia in many patients. The distinction between digitalis-induced arrhythmia and spontaneously occurring arrhythmia cannot be made with certainty in most postoperative patients. Therapy should reflect an awareness of the potential for postoperative digitoxicity.
对50例接受心脏手术的患者的心律失常情况进行了分析：其中27例接受瓣膜手术，15例接受冠状动脉搭桥术（CAB），5例接受CAB及瓣膜手术，3例接受其他手术。评估了电解质异常、心包炎、血清渗透压、地高辛水平及所施行手术类型的作用。50例患者中有37例（74%）术后出现心律失常，共记录到78种不同的心律失常。27例瓣膜手术患者中有26例出现心律失常，而15例CAB患者中有6例出现心律失常（p<0.001）。房颤是所有组中最常见的心律失常。虽然术后低钙血症、低镁血症、心包炎及渗透压大幅变化很常见，但它们与心律失常并无关联。17例患者出现与洋地黄毒性相符的术后心律失常，包括交界性心律、房室分离或伴有阻滞的房性心动过速。然而，这些患者的血清地高辛水平范围为0至2.80纳克/毫升。这表明在许多患者中，心律失常的病因可能是对洋地黄苷的敏感性增加或手术创伤的影响。在大多数术后患者中，无法确切区分洋地黄引起的心律失常和自发发生的心律失常。治疗应考虑到术后洋地黄中毒的可能性。
