优化麻醉管理策略预防普胸手术中病人心跳骤停发生的效果

Efficacy of strategy of optimizing anesthetic management in preventing occurrence of cardiac arrest during thoracic surgery

本院自2012年1月1日起对所有普胸手术病人采用优化麻醉管理方案：常规心电图联合有创动脉压监测、建立双腔中心静脉导管通路、发生严重心动过缓（HR〈40次/min）时立即干预并及时心脏按压。查询2006年7月1日至2011年12月31日（优化麻醉管理前）15 212例病人的麻醉记录，查询2012年1月1日至2015年1月15日（优化麻醉管理后）17 078例病人的麻醉记录，收集术中发生心跳骤停病人一般资料、心跳骤停发生的时间段、原因、抢救时间、抢救措施、复苏成功和预后的数据。优化麻醉管理前28例病人发生心跳骤停，发生率为0.184%，25例复苏成功，复苏成功率为89%，其中3例因大出血诱发心跳骤停复苏失败；优化麻醉管理后17例病人发生心跳骤停，发生率为0.109%，无一例病人因大出血诱发心跳骤停，复苏成功率为100%；复苏成功的病人术后均预后良好。与优化麻醉管理前比较，优化麻醉管理后心跳骤停发生率降低（P＝0.05），其它指标比较差异无统计学意义（P〉0.05），优化麻醉管理后心跳骤停发生率降低程度为45%。综上所述，优化麻醉管理策略有助于进一步降低普胸手术中病人心跳骤停发生。

The strategy of optimizing anesthetic management was carried out in all the patients undergoing thoracic surgery in our hospital from January 1, 2012： the patients were monitored using routine electrocardiogram combined with invasive arterial blood pressure monitoring, double-lumen central venous catheter pathway was established, and when severe bradycardia （heart rate〈40 beats/min） occurred, intervention was carried out immediately, and chest compression was performed timely.Medical records of 15 212 patients from July 1, 2006 to December 31, 2011 （before optimizing anesthetic management） as well as medical records of 17 078 patients from January 1, 2012 to January 15, 2015 （after optimizing anesthetic management） were reviewed.The data including baseline patient characteristics as well as the time period and causes of cardiac arrest, rescue time, rescue measures, successful resuscitation and prognosis in the patients developing intraoperative cardiac arrest were collected.Before optimizing anesthetic management, 28 patients developed cardiac arrest, the incidence was 0.184%, successful resuscitation was found in 25 cases, the success rate of resuscitation was 89%, and there were 3 cases in whom resuscitation failed due to massive hemorrhage-induced cardiac arrest.After optimizing anesthetic management, 17 patients developed cardiac arrest, the incidence was 0.109%, massive hemorrhage-induced cardiac arrest was not found in patients, and the success rate of resuscitation was 100%.Prognosis was good after surgery in successfully resuscitated patients.Compared with the values before optimizing anesthetic management, the incidence of cardiac arrest was significantly decreased （P=0.05）, and no significant change was found in the other parameters after optimizing anesthetic management （P〉0.05）, and the incidence of cardiac arrest was decreased by 45% after optimizing anesthetic management.In conclusion, the strategy of optimizing anesthetic management is helpful in decreasing the occurrence of cardiac arrest during thoracic surgery.