麻醉期間心跳驟停常見原因分析

1、術(shù)中心跳驟停相關(guān)性因素分析術(shù)中心跳驟停相關(guān)性因素分析JapanSocietyofAnesthesiologists(JSA)CertifiedTrainingHospitals(CTH) Atotalnumberof793,840anesthetics Totalincidenceofcardiacarrestunderanesthesia/surgerywas6.53per10,000anestheticsprincipalcausesoftotalcardiacarrestcases PC42.9%, IP22.0% SG21.4% AM12.0%(AM:incidencerateof0.

2、78per10,000) (PC)preoperativecomplications (IP)intraoperativepathologicalevents (SG)surgery (AM)anestheticmanagementIn52moredetailedclassificationofprincipalcausesofcardiacarrest themostfrequentcause preoperativehemorrhagicshock, 20.3%ofallcardiacarrests. Thesecondcause massivehemorrhageand/orhypovo

3、lemiaduetosurgicalprocedures(13.1%), thethirdcause intraoperativemyocardialinfarction/coronaryischemia/coronaryspasm(9.5%)Prognosesofcardiacarrest declinedduetoPC:71.1%ofcardiacarrestsdiedintheoperatingroomorwithin7daysaftersurgeryandonly19.8%survivedwithoutsequelae. ThebestprognosesduetoAM:69.4%sur

4、vivedwithoutsequelaeand12.9%died.themortalityratepost-cardiacarrest 3.44per10,000anesthetics, ofthose0.10duetoAM,0.57duetoIP,0.76duetoSG,1.99duetoPC.US teaching hospital 13yearsfromtheUniversityofPittsburghMedicalCenter(UPMC)betweenJanuary1,1989toDecember31,2001 218274anesthesiacases,including 20338

5、2generalanesthesiacases, 12282spinalanesthesiacases 2610epiduralanesthesiacases intraoperativecardiacarrestfromallcauseswas1.05per10000anesthetics duetoanesthesiaof0.45per100000 (60.8%)diedintheoperatingroomCharacteristics of intraoperative cardiac arrestaremarkablepercentageofpatients(86.9%)whohadi

6、ntraoperativecardiacarrestwereclassifiedasASAPSIVorV.SurvivalwassignificantlyimprovedinpatientswithASAPSIIII(66.7%)comparedwiththosewithASAPSIVV(35%).thesurvivalratewaslowerinpatientsolderthan65years(20%)comparedtopatientsyoungerthan64yearsold(53.5%).Asystolewasthemostcommon(52%)oninitialEKGrhythm,a

7、ndthosepatientsseemedlesslikelytosurviveafterresuscitationcomparedtootherrhythmssuchasPEAandVF;Characteristics of intraoperative cardiac arrest Therewasnodifferencebetweenmalesandfemalesinthesurvivalrate therewerenosignificantdifferencesinpatientssurvivalrateswithtrauma(50%)oremergencysurgery(42%)comparedwithnon-trauma(36%)orelectivesurgery(36%)尋找6H/5T，對(duì)尋找可能導(dǎo)致心搏驟停的原因很有幫助6H 低血容量hypovolemia 低氧血癥hypoxia 氫離子（酸中毒）hydrogenion(acidosis) 低高鉀血癥hypo-/hyperkalemia 低血糖hypoglycemia 低體