Key words esophageal circumference operative at surgery in elderly
Were treated in our department from January 1992 to December 2006, 15 years, 82 cases of esophageal cancer patients over the age of 70, including surgery, postoperative arrhythmia in 24 cases, 6 cases of cardiac dysfunction, reported as follows.
1 Clinical data
This group of men and 68 cases, 14 females, aged 70 to 85 years, with an average of 74.6 years old. 27 cases of abnormal preoperative ECG tips, including 10 cases of atrial premature beats, atrial fibrillation in eight cases, two cases of sinus bradycardia (atropine experiments were negative), the left branch block three cases, incomplete right bundle branch block in 2 cases and incomplete right bundle branch block. Surgical line esophagogastric cervical anastomosis 71 cases, 11 cases left thoracotomy arch anastomosis.
Postoperative entirely multifunction life monitor for continuous monitoring at least postoperative 72 h ventricular dysfunction caught line bedside echocardiography examination.
Group of patients no operative deaths, 24 cases of arrhythmia, including three cases of sinus tachycardia; supraventricular arrhythmias in 12 cases, including six cases of atrial premature beats, atrial fibrillation in 4 cases, acceleration junctions escape rhythm cases; 4 cases of premature ventricular contractions; another five cases the performance of different types of arrhythmia mixed episodes: frequent atrial premature beat and premature ventricular contractions, atrial fibrillation and supraventricular tachycardia, sinus tachycardia and one supraventricular tachycardia, atrial premature beats and supraventricular tachycardia. The ventricular dysfunction six cases, including five cases of left ventricular diastolic dysfunction.
The study found that the old age, preoperative arrhythmia, hypokalemia, intraoperative and postoperative hypoxia and so is the cause of postoperative arrhythmias in patients with high-risk factors [1,2]. This group of patients the preoperative ECG abnormalities ratio is 41.7% (10/24), higher than the corresponding technique combined with arrhythmia the postoperative arrhythmia ratio of 29.3% (17/58) (P <0.05). Intraoperative in the separation esophageal process of lung tissue extrusion, can cause hypoventilation, hypoxemia, induced arrhythmia. Oka et al  proposed intraoperative cardiac autonomic nerve damage and the incidence of arrhythmias is closely related. High esophagectomy vagotomy, may damage the heart fans nerves increase the refractory period of the myocardial tissue heterogeneity, easy to produce exhumation movement and trigger excitement induced arrhythmias .
As Thoracostomach compression of the trachea, narrowing the airway. Poor postoperative physical, incision pain, coughing, weakness resulting in secretion retention, especially preoperative, postoperative atelectasis, lung infections and hypoxemia more likely to have long-term heavy smoking history, causing arrhythmia. Seven cases of arrhythmia in oxygen saturation <90%, by the bedside bronchoscopy suction, to strengthen anti-inflammatory treatment, hypoxia improved the arrhythmia gradually disappear.
Anesthetic to avoid hypoventilation; the rehydration Note added colloid, to maintain access to the balance; surgical operation to minimize squeezing and pulling for hilar lung tissue; adequate oxygen after appropriate analgesia. If sputum laborious, should actively bedside bronchoscopy to improve ventilation. Arrhythmia treatment in addition to treatment for the cause, and its main purpose is to control the ventricular rate and the prevention of thrombosis.
3.2 ventricular dysfunction
Elderly patients before surgery may be inadequate myocardial blood supply or cardiac conduction system abnormalities, surgical trauma, hypoventilation, hypoxia and other factors can affect cardiac systolic and diastolic movement, increase the burden on the heart . We experience should pay attention to whether the merger of left ventricular diastolic dysfunction, especially in patients with hypertension and left ventricular hypertrophy and ischemic heart disease. The occurrence of impaired left ventricular diastolic diastolic compliance reduced left ventricular diastolic pressure was significantly higher the inverse spread to the lung system pressure cycle can lead to pulmonary venous congestion, pulmonary edema. The clinical manifestations and left ventricular systolic dysfunction similar. The group of five cases of postoperative ventricular dysfunction performance, patients have chest tightness, shortness of breath, increased heart rate, lungs heard and moist rales clinical symptoms, give the the cardiac Cedilanid condition improved after diuretic furosemide treatment obvious. The bedside echocardiography examinations showed left ventricular systolic function, mitral inflow A peak-to-peak filling rate higher than the peak E, considered as left ventricular diastolic dysfunction, change to the of β blockers and calcium antagonists treatment The condition can be improved.