成人先天性心脏病开胸过程突发室颤的原因分析及处理

Cause analysis and treatment of sudden ventricular fibrillation of adult congenital heart disease （ACHD） open thoracotomy

目的 探讨成人先天性心脏病（ACHD）开胸过程突发室颤的原因、治疗策略及预防措施.方法 分析1992年以来我院5例ACHD患者开胸过程发生室颤的临床资料.结果 开胸过程发生室颤的5例患者经处理均恢复为术前心律,4例继续完成心内畸形矫治手术,1例放弃手术,术后死亡.结论 ACHD开胸过程突发室颤与长期心内异常分流导致心脏结构改变、心肌功能障碍有关,麻醉及开胸时手术刺激也有可能诱发.应立即进行胸内心脏按压以保证有效循环,尽可能早地进行胸内电除颤复律,根据复苏效果判断机体能否耐受继续手术.

Objective To investigate the causes, treatments and prevention strategies of sudden ventricular fibrillation of adult congenital heart disease （ACHD） open thoracotomy. Methods 5 patients with sudden ventricular fibrillation during open thoracotomy were analyzed. Results 5 patients with sudden ventricular fibrillation after the treatment restored to the preoperative rhythm of the heart, four cases continued to complete corrective intracardiac anomalies surgery, one case gave up to continue operation and died. Conclusion Causes of sudden ventricular fibrillation during open thoracotomy of ACHD correlate with long - term abnormal heart shunt, which leads to the changes of cardiac structure, cardiac dysfunction, and anesthesia and thoracotomy surgical stimulation may also trigger. Immediate chest cardiac compression in order to ensure effective circulation and thoracic defibrillation cardioversion as early as possible should be taken, and to determine the body will withstand continued operation according to the recovery effect.