心脏直视手术心搏骤停26例原因分析及救治体会

Analysis and Management of 26 Cases with Cardiac Arrest During or Shortly After Open-heart Surgery

对26例（38次）体外循环心脏直视手术中和术后早期心搏骤停病人进行病因分析，总结救治经验。病因有动脉大量空气栓塞、鱼精蛋白过敏性休克、电解质紊乱、严重缺氧、低心排综合征、畸形矫治不良等。主要救治措施：心脏按压、心肺机辅助循环、心血管兴奋药物、上腔静脉及右心房逆行灌注、纠正电解质紊乱等。作者认为要重视镁缺乏导致的心律失常、心搏骤停。对体外循环手术病人，尤其有慢性心功能不全者，围术期应注意补镁、监测血清镁浓度，及时纠正镁缺乏。

causes of cardiac arrest during or shortly after cardiopulmonary bypass(CPB) surgery were analyzed in 26 cases (38 times). The causes of cardiac arrest are massive arterial air embolism, anaphylactic shock induced by protamine, electrolyte disturbance, serious anoxia, low cardiac output, incomplete repair of cardiac malformation,etc. The major managements are cardiac massage, CPB circulatory assist, cardiovascular stimulant, retrograde perfusion through superior vena cava and right atrium, correction of electrolyte disturbance and so on. The authors suggest that attention should be given to the arrhythmia and cardiac arrest caused by magnesium depletion. Replenishing magnesium during perioperation period, plama magnesium surveillance and correcting magnesium depletion promptly for patients undergoing CPB operation, especially for those having chronic heart failures, should also be emphasied.