Amar D, Roistacher N, Burt M, Reinsel R A, Ginsberg R J, Wilson R S
Department of Anesthesiology, Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Chest. 1995 Aug;108(2):349-54. doi: 10.1378/chest.108.2.349.
Supraventricular tachydysrhythmias (SVTs) following thoracic surgery occur with significant frequency and may be associated with increased morbidity. Prospective data on the etiology and importance of these dysrhythmias are sparse.
In 100 patients undergoing pulmonary resection without history of atrial dysrhythmias or previous thoracic surgery, we examined the effects of predefined risk factors by history, pulmonary function, and echocardiography on the incidence of postoperative SVT. Serial echocardiograms were performed preoperatively, on postoperative day 1, and again between postoperative days 2 to 6 (median = 3) to evaluate cardiovascular function and to estimate right ventricular systolic pressure (RVSP) by the tricuspid regurgitation jet (TRJ) Doppler velocity method.
Symptomatic postoperative SVT occurred in 18 (18%) of the 100 patients studied at a median of 3 days after surgery and was disabling in 12 of 18 (67%). Digoxin loading was ineffective in controlling the ventricular response in 16 of 17 episodes. In the patients developing SVT, postoperative echocardiography revealed significant elevation of TRJ Doppler velocity (2.7 +/- 0.6 m/s vs 2.3 +/- 0.6 m/s, p < 0.05) but not right atrial or ventricular enlargement or right atrial pressure increase when compared with patients without SVT. Independent correlates of SVT determined in a stepwise logistic regression included intraoperative blood loss > or = 1 L (p = 0.0001) and a postoperative TRJ Doppler velocity > or = 2.7 m/s (p < 0.05). Patients who developed SVT had a higher rate of intensive care unit admission (p < 0.004), a longer hospital stay (p < 0.02), and higher 30-day mortality (p < 0.02).
These prospective data suggest that increased right heart pressure but not fluid overload or right heart enlargement predisposes to clinically significant SVT after pulmonary resection. SVT may be an important marker of poor cardiopulmonary reserve in patients who develop significant morbidity after thoracic surgery. Early interventions to reduce right heart pressure may decrease the incidence of postoperative SVT and potentially improve overall surgical outcomes.
胸外科手术后室上性快速心律失常（SVT）的发生率较高，且可能与发病率增加有关。关于这些心律失常的病因和重要性的前瞻性数据较少。
在100例无房性心律失常病史或既往胸外科手术史的接受肺切除术的患者中，我们通过病史、肺功能和超声心动图检查了预先定义的危险因素对术后SVT发生率的影响。术前、术后第1天以及术后第2至6天（中位数=3天）再次进行系列超声心动图检查，以评估心血管功能，并通过三尖瓣反流射流（TRJ）多普勒速度法估计右心室收缩压（RVSP）。
在研究的100例患者中，有18例（18%）在术后中位3天出现有症状的术后SVT，其中12例（67%）导致功能障碍。在17次发作中的16次，地高辛负荷量对控制心室反应无效。与未发生SVT的患者相比，发生SVT的患者术后超声心动图显示TRJ多普勒速度显著升高（2.7±0.6 m/s对2.3±0.6 m/s，p<0.05），但右心房或心室无扩大，右心房压力也未升高。逐步逻辑回归确定的SVT独立相关因素包括术中失血≥1 L（p=0.0001）和术后TRJ多普勒速度≥2.7 m/s（p<0.05）。发生SVT的患者重症监护病房入住率更高（p<0.004），住院时间更长（p<0.02），30天死亡率更高（p<0.02）。
这些前瞻性数据表明，肺切除术后右心压力升高而非液体超负荷或右心扩大易导致具有临床意义的SVT。SVT可能是胸外科手术后发生严重并发症的患者心肺储备功能差的重要标志。早期降低右心压力的干预措施可能会降低术后SVT的发生率，并有可能改善总体手术结局。
