小儿心脏术后早期心律失常
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Arrhythmias in Children in Early Postoperative Period After Cardiac Surgery
背景与目的
心律失常是先天性心脏病心脏修复术后的一种相关并发症。
方 法
对369例18岁以下的患者进行择期心脏直视手术术后心律失常的发生率，诊断，潜在危险因素和治疗处理进行回顾性分析。所有儿童都被送入重症监护病房，并进行持续的心电图监测。分析患者心律失常发生因素，如亚里士多德基础复杂度评分，总手术持续时间，低血压，心动过速，血清乳酸水平和心肌收缩力评分。单因素分析评估这些因素与术后心律失常发生的关系。
结 果
25例（6.7％）患者发生心律失常。其中交界性异位心动过速（JET）15例（60％）是患者最常见的心律失常，其次为3例（12％）室上性心动过速，3例（12％）室性早搏，3例 （12％）血流动力学不稳定性室性心动过速和1例（4％）心房纤颤。13例患者出现不同程度的心脏阻滞。 亚里士多德评分（P = 0.014），总手术时间（P <0.01），低血压（P = 0.02），心率（每分钟搏动次数）（P = 0.001），血清乳酸水平（P = 0.04），术后早期肌力评分（P = 0.02）与心律失常发生相关。单独或与其他疾病相关的室间隔缺损手术，包括法洛四联症（TOF）和大动脉转位（TGA）被发现与心律失常风险较高相关。
结 论
本研究表明心律失常发生率较低，其中JET是最常见的，在TOF修复术中可以观察到更多的心律失常，但这些心律失常可以得到有效治疗。较高的亚里士多德评分，较长的手术时间，低血压，心动过速，高心肌收缩力评分和高血清乳酸水平与术后心律失常的发生有关。
原始文献摘要
Sahu M K, Das A, Siddharth B, et al. Arrhythmias in Children in Early Postoperative Period After Cardiac Surgery[J]. World J Pediatr Congenit Heart Surg, 2018, 9(1):38-46.
Background: Postoperative arrhythmias are a known complication after cardiac surgical repairs for congenital heart disease.
Methods: Data were reviewed pertaining to incidence, diagnosis, potential risk factors, and management of postoperative arrhythmias in 369 consecutive patients under 18 years of age, undergoing elective open heart surgery. All children were admitted to the intensive care unit and continuous electrocardiographic monitoring was performed. Patient factors such as Aristotle Basic Complexity Score, total surgical duration, hypotension, tachycardia, serum lactate level, and inotropic score were analyzed. Univariate analysis was done to assess associations between these factors and the occurrence of postoperative arrhythmias.
Results: Twenty-five (6.7%) patients developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia occurring in 15 (60%) patients, followed by supraventricular tachycardia in 3 (12%), ventricular premature contractions in 3 (12%), hemodynamically unstable ventricular tachycardia and fibrillation in 3 (12%), and atrial fibrillation in 1 (4%) patient. Different grades ofheart block were noted in 13 patients. Aristotle score (P =0.014), total surgical duration (P < .01), hypotension (P = .02), heart rate (beats per minute) (P = .001), serum lactate level (P = .04), and inotropic score (P =.02) in the early postoperative period were associated with arrhythmia occurrence. Surgeries for ventricular septal defect alone or in association with other diseases including tetralogy of Fallot (TOF) and transposition of the great arteries (TGA) were found to be associated with higher risk of arrhythmias.
Conclusion: This study showed a low incidence of arrhythmias, JET being the commonest, seen more in TOF repair and these could be treated efficiently. Higher Aristotle score, longer surgical time, hypotension, tachycardia, high inotropic score, and high serum lactate levels were associated with the occurrence of arrhythmias postoperatively.
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