影响术中心跳骤停后复苏成功率的因素分析

Analysis of risk factors on resuscitation outcome after intraoperative cardiac arrest

目的为了分析影响术中心跳骤停复苏成功率的危险因素，我们搜集了我院术中心跳骤停患者的数据，进行回顾性研究。方法整理了2005年1月～2009年12月期间病历记载的非心脏手术患者麻醉、手术期间心跳骤停的病例资料。结果在此期间共有48164例患者（局部麻醉除外）在我院接受麻醉实施非心脏手术。共有16例患者发生术中心跳骤停，发生率为3．32／10000，心跳骤停后的即时复苏成功率为9／16（56％）。患者年龄、性别、体重和术前的血流动力学状况在复苏成功和失败两组间差异无统计学意义。患者术前血红蛋白浓度复苏失败组（115±30）g，L显著低于复苏成功组[（133±17）g／L，P〈0．05]，复苏成功组ASA分级显著低于复苏失败组（P〈0．05）。与ASA分级为Ⅲ级或更高级别比较，ASA分级为Ⅰ或Ⅱ的患者生存率更高（P〈0．05）。麻醉方法对患者复苏成功与失败的影响差异无统计学意义（P〉0．05）。患者术前血糖值和心电图（EGG）显示的ST-T改变在复苏成功和失败两组之间差异无统计学意义（P〉0．05）。在这16例患者中，12例患者（75％）术前有缺血性ECG改变，5例患者（31％）发生心跳骤停主要原因为大量失血。结论术中心跳骤停与术前患者ECG缺血性改变相关。患者术前低血红蛋白浓度和高ASA分级是术中心跳骤停患者难以复苏的危险因素。

Objective To retrospectively investigate the risk factors affecting the outcome of resuscitation after intraoperative cardiac arrest in our hospital. Methods Medical records of patients experiencing intraoperative cardiac arrest in noncardiac surgery between January, 2005 and December, 2009 were reviewed. Results 48 164 patients of noncardiac surgical procedures were identified. There were 16 patients who occurred intraoperative cardiac arrest and the incidence was 3.32/10 000. Immediate survival rate after resuscitation was 9/16 （56%）. There were no significant difference in age, gender, weight, and hemodynamic status of patients before the surgery on successful resuscitation. The preoperative hemoglobin concentration was lower in patients with successful resuscitation （115±30） g/L than those with unsuccessful resuscitation [ （133±17） g/L, P〈0.05 ]. The pre-operation ASA physical status （ASA PS） in the patients with successful resuscitation was higher compared to unsuccessful resuscitation （P〈0.05）. Survival rate was significantly higher in patients with ASA PS of Ⅰ or Ⅱ compared to those with ASA PS of III or higher. Preoperative blood glucose value and ST-T segment changes in electrocardiogram （ECG） didn＇t differ between two groups （P〉0.05）. And the methods of anesthesia had no effects on the survival rate. Among 16 patients with cardiac arrest, 12 patients （75%） had preoperative ischemic ECG changes and 5 patients （31%） had massive blood loss. Conclusions Intraoperative cardiac arrest was related to preoperative ischemic ECG changes. Lower preoperative hemoglobin concentration and higher ASA PS could be the risk factors for the death of patients with intraoperative cardiac arrest.