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1、术中心跳骤停相关性因素分析术中心跳骤停相关性因素分析JapanSocietyofAnesthesiologists(JSA)CertifiedTrainingHospitals(CTH)Atotalnumberof793,840anestheticsTotalincidenceofcardiacarrestunderanesthesia/surgerywas6.53per10,000anestheticsprincipalcausesoftotalcardiacarrestcasesPC42.9%,IP22.0%SG21.4%AM12.0%(AM:incidencerateof0.78per1
2、0,000)(PC)preoperativecomplications(IP)intraoperativepathologicalevents(SG)surgery(AM)anestheticmanagementIn52moredetailedclassificationofprincipalcausesofcardiacarrestthemostfrequentcausepreoperativehemorrhagicshock,20.3%ofallcardiacarrests.Thesecondcausemassivehemorrhageand/orhypovolemiaduetosurgi
3、calprocedures(13.1%),thethirdcauseintraoperativemyocardialinfarction/coronaryischemia/coronaryspasm(9.5%)PrognosesofcardiacarrestdeclinedduetoPC:71.1%ofcardiacarrestsdiedintheoperatingroomorwithin7daysaftersurgeryandonly19.8%survivedwithoutsequelae.ThebestprognosesduetoAM:69.4%survivedwithoutsequela
4、eand12.9%died.themortalityratepost-cardiacarrest3.44per10,000anesthetics,ofthose0.10duetoAM,0.57duetoIP,0.76duetoSG,1.99duetoPC.US teaching hospital13yearsfromtheUniversityofPittsburghMedicalCenter(UPMC)betweenJanuary1,1989toDecember31,2001218274anesthesiacases,including203382generalanesthesiacases,
5、12282spinalanesthesiacases2610epiduralanesthesiacasesintraoperativecardiacarrestfromallcauseswas1.05per10000anestheticsduetoanesthesiaof0.45per100000(60.8%)diedintheoperatingroomCharacteristics of intraoperative cardiac arrestaremarkablepercentageofpatients(86.9%)whohadintraoperativecardiacarrestwer
6、eclassifiedasASAPSIVorV.SurvivalwassignificantlyimprovedinpatientswithASAPSIIII(66.7%)comparedwiththosewithASAPSIVV(35%).thesurvivalratewaslowerinpatientsolderthan65years(20%)comparedtopatientsyoungerthan64yearsold(53.5%).Asystolewasthemostcommon(52%)oninitialEKGrhythm,andthosepatientsseemedlesslike
7、lytosurviveafterresuscitationcomparedtootherrhythmssuchasPEAandVF;Characteristics of intraoperative cardiac arrestTherewasnodifferencebetweenmalesandfemalesinthesurvivalratetherewerenosignificantdifferencesinpatientssurvivalrateswithtrauma(50%)oremergencysurgery(42%)comparedwithnon-trauma(36%)orelectivesurgery(36%)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toxins心包压塞tamponade,cardiac张力性气胸tensionpneumothorax栓塞（冠脉或肺）thrombosis(coronaryorpulmonary)创伤trauma
