摘要
目的 探讨支气管肺泡灌洗术对重度肺炎患儿心脏节律及传导的影响.方法 2011年7月至2012年3月,选择在大连市儿童医院呼吸科住院并符合纳入标准及适应证的30例重度肺炎患儿,其中男17例、女13例,平均年龄5.3岁.采用连续采样的方法,在支气管肺泡灌洗术前、麻醉、入声门、注液、吸引、苏醒环节进行心电图检查,并测量心电图中心率、节律、P波振幅及宽度、PR间期、QRS波形态及宽度,对所记录数据进行统计学分析.结果 30例患儿行支气管肺泡灌洗术整个操作过程中除P波外,其余心电图指标均出现异常.30例患儿均出现心率增快,26例（86.7％）患儿从麻醉开始后即开始明显增快,4例在气管镜操作开始后也出现,均为窦性心动过速,以注液及苏醒时最明显[（155±15）和（155±19）次/min].13例（43.3％）患儿在入声门、注液、吸引环节中出现除窦性心动过速以外的心律失常（窦性心动过缓、房室传导阻滞、早搏）.术中心律失常发生率与术前、术后相比较,差异均有统计学意义（P=0.00）.对出现心律失常的环节之间进行比较,差异均无统计学意义（P=0.83）.心律失常以早搏最多见（17例次）,其中9例房性早搏,8例室性早搏,两组差异无统计学意义（P=0.77）.心律失常组低氧血症伴随比例与未发生心律失常组差异有统计学意义（12/21比4/17,x2=4.35,P=0.04）.入声门过程中有2例患者发生Ⅲ度房室传导阻滞伴有明显窦性心动过缓,经及时处理后恢复.操作结束进入苏醒环节后心律失常均恢复正常.5例（16.7％）患儿在各环节出现PR间期延长,其中3例患儿在≥2个环节均有PR间期延长,1例患儿直至麻醉苏醒PR间期仍未恢复正常,术中与术前及术后相比较差异均无统计学意义[13.3％（4例）比0（0例）和3.3％（1例）,均P＞0.05].对出现PR间期异常的各个环节进行比较,PR间期异常率差异无统计学意义（P=0.81）.5例（16.7％）患儿QRS波可见不完全性右束支传导阻滞（IRBBB）现象,其中4例（13.3％）患儿在≥2个环节均发生IRBBB现象,术中与术前及术后差异均无统计学意义[13.3％（4例）比0（0例）和3.3％（1例）,均P＞0.05].对出现IRBBB现象的各个环节进行比较,发生率差异无统计学意义（P=0.82）.不同环节对除心率以外的心电图各个测量值的影响差异均无统计学意义（均P ＞0.05）.结论 支气管肺泡灌洗术对心脏电生理存在影响,但影响不大,持续时间不长;从心电生理角度来看,支气管肺泡灌洗术的安全性可以得到保证.
Objective To observe the effect of bronchoalveolar lavage on the heart rhythm and conduction of children with severe pneumonia through monitoring the electrocardiogram change of different step of the bronchoalveolar lavage,for proving the safety of the operation of bronchoalveolar lavage from the perspective of cardiac electrophysiology.Method From July 2011 to March 2012,30 patients who were hospitalized in pneumology department of Dalian Children＇s Hospital and met the inclusion criteria and therapeutic indications of bronchoalveolar lavage were chosen.They were 3 to 12 years old,the average age was 5.3 years,including 17 boys and 13 girls,the ratio of boys and girls is 1.3∶ 1.Continuous sampling the electrocardiogram before and duriug the process including anesthesia,entering into glottis,lavage,aspiration,and revive,and recording the heart rate,rhythm amplitude and width of P wave,the PR interval,the form and width of QRS complex were also measured.The recorded data were analyzed and statistical analysis to reflect the change of the cardiac electrophysiology.Result The incidence of heart rate increase was 100.0％,26 （86.7％） patients began to emerge after anesthesia,the rest of the patients also developed heart rate increase after the start of bronchoscopic operation.All patients had sinus tachycardia,and were most obvious in the progress of lavage and revive.In the process of entering into glottis,lavage,aspiration,13 （43.3％）patients had arrhythmia episodes.Types of arrhythmia included sinus bradycardia,atrioventricular block and premature beat.Incidences of intraoperative arrhythmia compared with the preand post-operation were all statistically significantly different （P =0.00）.The most common arrhythmia were premature beat,in 17 of the 30 cases there were premature beat including 9 cases with atrial premature beats and 8 cases ventricular premature contraction.Two patients had Ⅲ ° atrioventricular block accompanied by serious sinus bradycardia.All kinds of arrhythmias except sinus tachycardia disappeared after the operation was ended.Five patients （16.7％） had PR interval prolongation.Five patients （16.7％） had incomplete right bundle branch block（IRBBB）.Incidences of IRBBB compared with the pre-operation and post-operation were all not significantly different [13.3％ （n =4） vs.0（n =0） and 3.3％ （n =1）,all P ＞ 0.05].Different operating progress made no significant difference in the measurement value of electrocardiogram[13.3％ （n =4） vs.0（n =0） and 3.3％ （n =1）,all P ＞ 0.05],but showed the most notable effect on heart rate.Conclusion Bronchoalveolar lavage can influence the heart rhythm and conduction,but most of the influence with pathological significance are transient.Cardiac electrophysiological changes were the most obvious in endotracheal operation with the risk of malignant arrhythmia but the risk is low,the bronchoalveolar lavage technique is safe.The contingency plans for dealing with all kinds of adverse reactions must be ready before the operations of bronchoalveolar lavage.During the procedure,the patient＇s ECG changes should be closely monitored to reduce the incidence of adverse reactions.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2014年第4期252-256,共5页
Chinese Journal of Pediatrics
关键词
支气管肺泡灌洗
儿童
心电描记术
心脏电生理学
Bronchoalveolar lavage
Child
Electrocardiography
Cardiac electrophysiology
