术中心跳骤停:一所三甲教学医院6年内的回顾性研究

Perioperative cardiac arrest:a retrospective review of 6-year experience in a teaching hospital

目的回顾分析第二军医大学附属长征医院术中心跳骤停患者的医学资料,为防治这一严重术中意外事件提供一些有益的医学信息。方法对2001年1月—2006年12月在第二军医大学附属长征医院手术室接受非心脏手术时发生术中心跳骤停患者的医疗记录进行回顾分析,资料包括患者的病史、心跳骤停的原因、心肺复苏的过程以及预后情况。结果共72 822例患者接受麻醉手术,术中发生心跳骤停17例(2.33/10 000),其中全身麻醉15例,椎管内麻醉2例。2例(0.27/10 000)心跳骤停主要与麻醉相关。11例(64.7%,11/17)复苏成功,住院期间的存活率为58.8%(10/17)。肝移植手术期间发生心跳骤停6例(1.0%,6/581),死亡2例。结论术中心跳骤停的原因复杂,主要为高钾血症、迷走神经过度兴奋和大量失血。主要由于麻醉原因引起的心跳骤停非常少见,肝移植手术期间心跳骤停的发生率高。麻醉医师应警惕术中迷走神经过度兴奋可能造成的严重不良后果。迅速实施"快速、有力"的胸外按压是保证心脏和大脑成功复苏的关键。

Objective To retrospectively analyze the data of patients who developed cardiac arrest during operation in Changzheng Hospital, so as to provide evidence for prevention and treatment of such accidents in clinical practice. Methods The medical records of patients who experienced cardiac arrest during noncardiac surgery during January 2001 to December 2006 were retrospectively reviewed. The data collected included medical history, American Society of Anesthesiologists （ASA） physical status classification, surgical procedure, anesthetic technique, causes of arrest, process of resuscitation, and outcomes. Results Cardiac arrest occurred in 17 of 72 822 anesthetics （2.33 per 10 000 anesthetics）, including 15 receiving general anesthesia and 2 receiving intravertebral anesthesia. Two of the 17 cardiac arrests were primarily related to anesthesia （0.27 per 10 000 anesthetics）. Eleven of the 17 patients （64.7%） were successfully resuscitated, and the hospital survival rate was 58.8 % （10/17）. Six patients developed cardiac arrests during liver transplantation （1.0 %, 6/581 ）, and two of them died. Conclusion Causes of perioperative cardiac arrest are complex; the major causes are hyperkalemia, excessive vagal activity and massive blood loss. Cardiac arrest primarily related to anesthesia is rare, and the incidence of cardiac arrest during liver transplantation is high. Anesthesiologists should pay special attention to excessive vagal activity during operation, which may result in serious adverse events.＇ Performing chest compressions using uninterrupted ＂push hard, push fast＂ method promptly is vital for successful resuscitation of the heart and brain. （Shanghai Med J, 2009, 32： 952-955）