麻醉期间心跳骤停常见原因分析演示文稿

麻醉期间心跳骤停常见原因分析演示文稿当前第1页\共有18页\编于星期一\17点优选麻醉期间心跳骤停常见原因分析当前第2页\共有18页\编于星期一\17点当前第3页\共有18页\编于星期一\17点当前第4页\共有18页\编于星期一\17点Japan

Society

of

Anesthesiologists

(JSA)CertifiedTrainingHospitals(CTH)

Atotalnumberof

793,840anestheticsTotalincidenceofcardiacarrestunderanesthesia/surgerywas6.53per10,000anesthetics当前第5页\共有18页\编于星期一\17点principalcauses

oftotalcardiacarrestcasesPC42.9%,IP22.0%SG21.4%AM12.0%(AM:incidencerateof0.78per10,000)(PC)preoperativecomplications(IP)intraoperativepathologicalevents(SG)surgery(AM)anestheticmanagement当前第6页\共有18页\编于星期一\17点In52moredetailedclassification

ofprincipalcausesofcardiacarrestthemostfrequentcause

preoperativehemorrhagicshock,20.3%ofallcardiacarrests.Thesecondcause

massivehemorrhageand/orhypovolemiaduetosurgicalprocedures(13.1%),thethird

cause

intraoperativemyocardialinfarction/coronaryischemia/coronaryspasm(9.5%)当前第7页\共有18页\编于星期一\17点PrognosesofcardiacarrestdeclinedduetoPC:71.1%ofcardiacarrestsdiedinthe

operating

room

orwithin7daysaftersurgeryandonly19.8%survivedwithoutsequelae.ThebestprognosesduetoAM:69.4%survivedwithoutsequelaeand12.9%died.

当前第8页\共有18页\编于星期一\17点the

mortality

rate

post-cardiacarrest3.44per10,000anesthetics,ofthose0.10duetoAM,0.57duetoIP,0.76duetoSG,1.99duetoPC.当前第9页\共有18页\编于星期一\17点

USteachinghospital

13yearsfromtheUniversityofPittsburghMedicalCenter(UPMC)betweenJanuary1,1989toDecember31,2001218274anesthesiacases,including203382generalanesthesiacases,12282spinalanesthesiacases2610epiduralanesthesiacases当前第10页\共有18页\编于星期一\17点intraoperativecardiacarrestfromallcauseswas1.05per10000anestheticsduetoanesthesiaof0.45per100000

(60.8%)diedintheoperatingroom

当前第11页\共有18页\编于星期一\17点当前第12页\共有18页\编于星期一\17点当前第13页\共有18页\编于星期一\17点Characteristics

ofintraoperativecardiacarrest

aremarkablepercentageofpatients(86.9%)whohadintraoperativecardiacarrestwereclassifiedasASAPSIVorV.SurvivalwassignificantlyimprovedinpatientswithASAPSI–III(66.7%)comparedwiththosewithASAPSIV–V(35%).thesurvivalratewaslowerinpatientsolderthan65years(20%)comparedtopatientsyoungerthan64yearsold(53.5%).Asystolewasthemostcommon(52%)oninitialEKGrhythm,andthosepatientsseemedlesslikelytosurviveafterresuscitationcomparedtootherrhythmssuchasPEAandVF;当前第14页\共有18页\编于星期一\17点Characteristics

ofintraoperativecardiacarrest

Therewasnodifferencebetweenmalesandfemalesinthesurvivalratetherewerenosignificantdifferencesinpatients’survivalrateswithtrauma(50%)oremergencysurgery(42%)comparedwithnon-trauma(36%)orelectivesurgery(36%)当前第15页\共有18页\编于星期一\17点当前第16页\共有18页\编于星期一\17点寻找6H/5T，

对寻找可能导致心搏骤停的原因很有帮助当前第17页\共有18页\编于星期一\17点6H