麻醉期间心跳骤停常见原因分析课件

Japan

Society

of

Anesthesiologists

(JSA)CertifiedTrainingHospitals(CTH)

Atotalnumberof

793,840anestheticsTotalincidenceofcardiacarrestunderanesthesia/surgerywas6.53per10,000anestheticsprincipalcauses

oftotalcardiacarrestcasesPC42.9%,IP22.0%SG21.4%AM12.0%(AM:incidencerateof0.78per10,000)(PC)preoperativecomplications(IP)intraoperativepathologicalevents(SG)surgery(AM)anestheticmanagementIn52moredetailedclassification

ofprincipalcausesofcardiacarrestthemostfrequentcause

preoperativehemorrhagicshock,20.3%ofallcardiacarrests.Thesecondcause

massivehemorrhageand/orhypovolemiaduetosurgicalprocedures(13.1%),thethird

cause

intraoperativemyocardialinfarction/coronaryischemia/coronaryspasm(9.5%)PrognosesofcardiacarrestdeclinedduetoPC:71.1%ofcardiacarrestsdiedinthe

operating

room

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

the

mortality

rate

post-cardiacarrest3.44per10,000anesthetics,ofthose0.10duetoAM,0.57duetoIP,0.76duetoSG,1.99duetoPC.

USteachinghospital

13yearsfromtheUniversityofPittsburghMedicalCenter(UPMC)betweenJanuary1,1989toDecember31,2001218274anesthesiacases,including203382generalanesthesiacases,12282spinalanesthesiacases2610epiduralanesthesiacasesintraoperativecardiacarrestfromallcauseswas1.05per10000anestheticsduetoanesthesiaof0.45per100000

(60.8%)diedintheoperatingroomCharacteristics

ofintraoperativecardiacarrest

aremarkablepercentageofpatients(86.9%)whohadintraoperativecardiacarrestwereclassifiedasASAPSIVorV.SurvivalwassignificantlyimprovedinpatientswithASAPSI–III(66.7%)comparedwiththosewithASAPSIV–V(35%).thesurvivalratewaslowerinpatientsolderthan65years(20%)comparedtopatientsyoungerthan64yearsold(53.5%).Asystolewasthemostcommon(52%)oninitialEKGrhythm,andthosepatientsseemedlesslikelytosurviveafterresuscitationcomparedtootherrhythmssuchasPEAandVF;Characteristics

ofintraoperativecardiacarrest

寻找6H/5T，

对寻找可能导致心搏骤停的原因很有帮助6H－低血容量hypovolemia－低氧血症hypoxia－氢离子（酸中毒）hydrogenion(acidosis)－低／高钾血症hypo-/hyperkalemia－低血糖hypoglycemia－低体温hypothermia5T－中毒t