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1、术中心跳骤停相关性因素分析,JapanSocietyofAnesthesiologists(JSA) Certified Training Hospitals (CTH),A total number of 793,840 anesthetics Total incidence of cardiac arrest under anesthesia/surgery was 6.53 per 10,000 anesthetics,principal causes of total cardiac arrest cases,PC 42.9%, IP 22.0% SG 21.4% AM 12.0% (
2、AM:incidence rate of 0.78 per 10,000),(PC) preoperative complications (IP) intraoperative pathological events (SG) surgery (AM) anesthetic management,In 52 more detailed classification of principal causes of cardiac arrest,the most frequent cause preoperative hemorrhagic shock, 20.3% of all cardiac
3、arrests. The second cause massive hemorrhage and/or hypovolemia due to surgical procedures (13.1%), the third cause intraoperative myocardial infarction/coronary ischemia/coronary spasm (9.5%),Prognoses of cardiac arrest,declined due to PC: 71.1% of cardiac arrests died in theoperatingroomor within
4、7 days after surgery and only 19.8% survived without sequelae. The best prognoses due to AM: 69.4% survived without sequelae and 12.9% died.,themortalityrate post-cardiac arrest,3.44 per 10,000 anesthetics, of those 0.10 due to AM, 0.57 due to IP, 0.76 due to SG, 1.99 due to PC.,US teaching hospital
5、,13 years from the University of Pittsburgh Medical Center (UPMC) between January 1, 1989 to December 31, 2001 218 274 anesthesia cases, including 203 382 general anesthesia cases, 12 282 spinal anesthesia cases 2610 epidural anesthesia cases,intraoperative cardiac arrest from all causes was 1.05 pe
6、r 10 000 anesthetics due to anesthesia of 0.45 per 100 000 (60.8%) died in the operating room,Characteristics of intraoperative cardiac arrest,a remarkable percentage of patients (86.9%) who had intraoperative cardiac arrest were classified as ASA PS IV or V. Survival was significantly improved in p
7、atients with ASA PS IIII (66.7%) compared with those with ASA PS IVV (35%). the survival rate was lower in patients older than 65 years (20%) compared to patients younger than 64 years old (53.5%). Asystole was the most common (52%) on initial EKG rhythm, and those patients seemed less likely to sur
8、vive after resuscitation compared to other rhythms such as PEA and VF;,Characteristics of intraoperative cardiac arrest,There was no difference between males and females in the survival rate there were no significant differences in patients survival rates with trauma (50%) or emergency surgery (42%)
9、 compared with non-trauma (36%) or elective surgery (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）hydrogen ion (acidosis) 低高钾血症 hypo-/hyperkalemia 低血糖 hypoglycemia 低体温hypothermia,5T,中毒 toxins 心包压塞 tamponade ,cardiac 张力性气胸 tension pneumothorax 栓塞（冠脉或肺）thrombosis (coronary or pulmonary) 创伤 trauma,谢谢大家,