论文标题:食管癌术后并发心房颤动的临床研究
Clinical Research of the Atrial Fibrillation Complicated with the Esophagectomy
论文作者 黄海波
论文导师 韩振国,论文学位 硕士,论文专业 外科学
论文单位 吉林大学,点击次数 149,论文页数 43页File Size464k
2005-04-30论文网 http://www.lw23.com/lunwen_1709357/ 食管癌;手术;并发症;心房颤动
Carcinoma of the esophagus;Surgery;Complication; Atrial fibrillation
2002 年3 月至2005 年3 月在我科因食管癌行食管癌切除食管胃吻合术的192 例被纳入了我们的研究。我们对其进行了回顾性的临床分析,对患者的年龄、术前心电图异常(不包括术前患房颤)、术前高血压病史、手术方法、吻合位置等与术后并发房颤的关系进行了危险因素分析,同时对食管癌术后房颤与术后吻合口瘘及手术死亡率的关系进行了初步的研究,通过对两个病例术后心律失常的发展过程的系统观察,对食管癌术后房颤的发展过程进行分析。通过我们的研究发现,下列因素如:高龄(大于60 岁)、术前有心电图异常、术前患有高血压者术后房颤发生的机率明显增加;而手术方法与吻合位置与术后并发房颤则没有明显的联系。术后并发房颤明显的增加了术后吻合口瘘发生,但是对手术死亡率则没有明显的影响。在对两个病例术后心电图的动态分析中,我们发现两例患者的心律失常有一个从房性早搏到室上性心动过速到房颤的转变过程。结合最新的对初发的阵发性房颤机制的研究发现,我们分析后推测,食管癌术后并发房颤的发展是一个逐渐由房早到室上性心动过速最后到房颤的一个转变过程。通过及时对房颤高危因素的监测及干预治疗,可将房颤的发生率及对患者的影响降到最低。
Atrial fibrillation is one of the very common complications afteresophagectomy. It’s mobidity is still very high. To identify the risk factorsassociated with the onset of atrial fibrillation after esophagectomy and explore thedevelopment stages of it, we retrospectively analyzed 192 cases of esophagealcarcinoma who got the esophagectomy done in our department from March 2002to March 2005. We divided them into 2 groups according to the onset of atrialfibrillation after the operation. We selected the older age, the pre-operationelectrocardiogram abnormality, pre-operative hypertension, operation method,anastomosis position as the possible risk factors. Then we compared the twogroups’conditions of the risk factors. By using the statistic methods of χ2 test andodds ratio analysis, we analyzed the association and the association intensitybetween the onset of atrial fibrillation after esophagectomy and risk factors. Wealso analyzed the association of atrial fibrillation with the anastomotic leakage andsurgery death.Among the 192 cases, 24 cases had the atrial fibrillation after operation whichthe morbidity was 12.5%. The further statistic analysis about the association andthe association intensity between the onset of atrial fibrillation afteresophagectomy and risk factors revealed that: 1, older age, especially older than60-year old, was a risk factor associated with the atrial fibrillation afteresophagectomy and the association intensity was strong. 2, The pre-operationelectrocardiogram abnormality and the pre-operative hypertension were both riskfactors associated with the atrial fibrillation after esophagectomy and theassociation intensity were also strong. In the analysis of these two risk factors, inorder to avoid the affluence of the age, we used the stratifiedχ2 test and odds ratioanalysis by divided the two groups into two stratums according to whether the agewas over 60 or not. 3, The operation method and the anastomosis position were notassociated with the atrial fibrillation after esophagectomy. We conclude that olderage, pre-operation electrocardiogram abnormality and pre-operative hypertensionwere risk factors associated with the atrial fibrillation after esophagectomy and theassociation intensity were strong. This will provide us a criterion to evaluate therisk of the atrial fibrillation after esophagectomy and let us take some prophylaxismethod with the patients which had higher risks. The onset of atrial fibrillationevidently increased the happening possibility of the anastomotic leakage, but notincreased the operation death. When we considered the reasons for the risk factors, we thought that thepatients of older age, pre-operation electrocardiogram abnormality andpre-operative hypertension were more likely to have any functional or fundamentalchanges of the heart, like the ectopic pulse increase, sino-atrial nodus functiondecrease and the changes of the cardiac conduct route. Adding that during thecourse of the esophagectomy, we couldn’t avoid the touch of the posterior wall ofthe left atrium and the pulmonary veins. Any stimulates to the ectopic pulse pointsof the pulmonary veins may lead the onset of the atrial fibrillation afteresophagectomy. The onset of atrial fibrillation will lead to the disfunction of theatrium. The cardiac output will decrease by about 1/3. This will increase thehappening possibility of the anastomotic leakage. In the past, the development stages of the atrial fibrillation afteresophagectomy was not very clear. In our study, we found that the atrial fibrillationafter esophagectomy was developed from the atrial ectopic pulse to
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