【摘要】 目的　探讨心脏瓣膜置换术后室性心律异常的相关因素和规律 ,提高防治措施。方法　将 14 7例心脏单瓣膜置换、双瓣膜置换及瓣膜置换加左房血栓清除患者按术式分成 3组 ,按术式、血清钾浓度、主动脉阻断时间、心胸比例、心功能等在术后 60h内分成 5个时间段 ,分别观察记录偶发、频发室性早搏、室性二联律、三联律、室速、室颤例次 ,然后进行组间、多因素分析对比研究。结果　血钾 <3 .5mmol/L与 >4.1mmol/L组间对比 ,差异有非常显著性P <0 .0 1;主动脉阻断时间 >90min与 <60min组间相比 ,差异也有非常显著性P <0 .0 1;心胸比 >0 .8与 <0 .8组间相比 ,差异有显著性P <0 .0 5 ;心功能Ⅳ级与心功能Ⅱ级组两组相比 ,差异有非常显著性P <0 .0 1。结论心脏瓣膜替换术后引起室性心律增多的主要因素依次为血清钾 <3 .5mmoI/L组 ,主动脉阻断时间>90min组 ,心功能Ⅳ级组 ,心胸比 >0 .8组 ,及体外循环时间 >15 0min组 ,心率 <60次 /min组 ,AMP <5 0mmHg组 ,CVP >2 0cmH2 O组 ,及异丙基肾上腺素应用 >48h组。更多还原

【Abstract】 Objective To guide related factors and rules for abnormal rhythm of ventricles of heart after valve replacement were studied so as to improve prevention measures.Method Separate 147 patients into three groups following different ways of operation as follows:single valve replacement,duel valve replacement and valve replacement with removal of thrombus.Following way of operation,density of kalium in blood serum,interdiction time of aortic artery,ratio of heart and breast,heart function etc.separate 60 hours into 5 phases and record incidental ventricular premature beats,frequent ventricular beats,ventricular bigeminal pulse,trigeminal pulse,ventricular speed and times of ventricular beats.Now analyze and compare above mentioned groups and multi-factors.Result There is remarkable difference in P value between the following groups each:group with kalium in blood serum <3.5 mmol/L and more than 4.1 mmol/L P value is less than 0.01;group with aortic artery interdiction more than 90 minutes and less than 60 minutes P value is less than 0.01;group with heart and breast ratio >0.8 and <0.8 the P value is less than 0.05;group with heart function of grade Ⅳ and grade Ⅱ the P value is less than 0.01.Conclusion The main factors for increase of abnormal heart ventricle rhythm after operation of heart valve replacement is listed as below in order:group of patients with serum kalium <3.5 mmol/L;aortic artery interdiction time >90 minutes;heart function grade IV;heart and breast ratio >0.8;extracorporeal circulation time >150 minutes;heart rhythm 60< times/min.,AMP <50 mm Hg;CVP >20 mm H 2O and application of isoproterenol >48 hours.更多还原