麻醉期间心跳骤停常见原因分析

关于麻醉期间心跳骤停常见原因分析第一页，共十九页，编辑于2023年，星期四第二页，共十九页，编辑于2023年，星期四第三页，共十九页，编辑于2023年，星期四Japan

Society

of

Anesthesiologists

(JSA)CertifiedTrainingHospitals(CTH)

Atotalnumberof

793,840anestheticsTotalincidenceofcardiacarrestunderanesthesia/surgerywas6.53per10,000anesthetics第四页，共十九页，编辑于2023年，星期四principalcauses

oftotalcardiacarrestcasesPC42.9%,IP22.0%SG21.4%AM12.0%(AM:incidencerateof0.78per10,000)(PC)preoperativecomplications(IP)intraoperativepathologicalevents(SG)surgery(AM)anestheticmanagement第五页，共十九页，编辑于2023年，星期四In52moredetailedclassification

ofprincipalcausesofcardiacarrestthemostfrequentcause

preoperativehemorrhagicshock,20.3%ofallcardiacarrests.Thesecondcause

massivehemorrhageand/orhypovolemiaduetosurgicalprocedures(13.1%),thethird

cause

intraoperativemyocardialinfarction/coronaryischemia/coronaryspasm(9.5%)第六页，共十九页，编辑于2023年，星期四PrognosesofcardiacarrestdeclinedduetoPC:71.1%ofcardiacarrestsdiedinthe

operating

room

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

第七页，共十九页，编辑于2023年，星期四the

mortality

rate

post-cardiacarrest3.44per10,000anesthetics,ofthose0.10duetoAM,0.57duetoIP,0.76duetoSG,1.99duetoPC.第八页，共十九页，编辑于2023年，星期四

USteachinghospital

13yearsfromtheUniversityofPittsburghMedicalCenter(UPMC)betweenJanuary1,1989toDecember31,2001218274anesthesiacases,including203382generalanesthesiacases,12282spinalanesthesiacases2610epiduralanesthesiacases第九页，共十九页，编辑于2023年，星期四intraoperativecardiacarrestfromallcauseswas1.05per10000anestheticsduetoanesthesiaof0.45per100000

(60.8%)diedintheoperatingroom第十页，共十九页，编辑于2023年，星期四第十一页，共十九页，编辑于2023年，星期四第十二页，共十九页，编辑于2023年，星期四Characteristics

ofintraoperativecardiacarrest

aremarkablepercentageofpatients(86.9%)whohadintraoperativecardiacarrestwereclassifiedasASAPSIVorV.SurvivalwassignificantlyimprovedinpatientswithASAPSI–III(66.7%)comparedwiththosewithASAPSIV–V(35%).thesurvivalratewaslowerinpatientsolderthan65years(20%)comparedtopatientsyoungerthan64yearsold(53.5%).Asystolewasthemostcommon(52%)oninitialEKGrhythm,andthosepatientsseemedlesslikelytosurviveafterresuscitationcomparedtootherrhythmssuchasPEAandVF;第十三页，共十九页，编辑于2023年，星期四Characteristics

ofintraoperativecardiacarrest

Therewasnodifferencebetweenmalesandfemalesinthesurvivalratetherewerenosignificantdifferencesinpatients’survivalrateswithtrauma(50%)oremergencysurgery(42%)comparedwithnon-trauma(36%)orelectivesurgery(36%)第十四页，共十九页，编辑于2023年，星期四第十五页，共十九页，编辑于2023年，星期四寻找6H/5T，

对寻找可能导致心搏骤停的原因很有帮助第十六页，共十九页，编辑于2023年，星期四6H－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hypothermia第十七页，共十九页，编辑于2023年，星期四5T－中毒toxins