CAJ | 학술논문

目的为了分析影响术中心跳骤停复苏成功率的危险因素,我们搜集了我院术中心跳骤停患者的数据,进行回顾性研究.方法整理了2005年1月～2009年12月期间病历记载的非心脏手术患者麻醉、手术期间心跳骤停的病例资料.结果在此期间共有48 164例患者(局部麻醉除外)在我院接受麻醉实施非心脏手术.共有16例患者发生术中心跳骤停,发生率为3.32/10 000,心跳骤停后的即时复苏成功率为9/16(56％).患者年龄、性别、体重和术前的血流动力学状况在复苏成功和失败两组间差异无统计学意义.患者术前血红蛋白浓度复苏失败组(115±30)g/L显著低于复苏成功组[(133±17)g/L,P＜0.05],复苏成功组ASA分级显著低于复苏失败组(P＜0.05).与ASA分级为Ⅲ级或更高级别比较,ASA分级为Ⅰ或Ⅱ的患者生存率更高(P＜0.05).麻醉方法对患者复苏成功与失败的影响差异无统计学意义(P＞0.05).患者术前血糖值和心电图(ECG)显示的ST-T改变在复苏成功和失败两组之间差异无统计学意义(P＞0.05).在这16例患者中,12例患者(75％)术前有缺血性ECG改变,5例患者(31％)发生心跳骤停主要原因为大量失血. 结论术中心跳骤停与术前患者ECG缺血性改变相关.患者术前低血红蛋白浓度和高ASA分级是术中心跳骤停患者难以复苏的危险因素.
목적 위료분석영향술중심도취정복소성공솔적위험인소,아문수집료아원술중심도취정환자적수거,진행회고성연구.방법 정리료2005년1월～2009년12월기간병력기재적비심장수술환자마취、수술기간심도취정적병례자료.결과 재차기간공유48 164례환자(국부마취제외)재아원접수마취실시비심장수술.공유16례환자발생술중심도취정,발생솔위3.32/10 000,심도취정후적즉시복소성공솔위9/16(56％).환자년령、성별、체중화술전적혈류동역학상황재복소성공화실패량조간차이무통계학의의.환자술전혈홍단백농도복소실패조(115±30)g/L현저저우복소성공조[(133±17)g/L,P＜0.05],복소성공조ASA분급현저저우복소실패조(P＜0.05).여ASA분급위Ⅲ급혹경고급별비교,ASA분급위Ⅰ혹Ⅱ적환자생존솔경고(P＜0.05).마취방법대환자복소성공여실패적영향차이무통계학의의(P＞0.05).환자술전혈당치화심전도(ECG)현시적ST-T개변재복소성공화실패량조지간차이무통계학의의(P＞0.05).재저16례환자중,12례환자(75％)술전유결혈성ECG개변,5례환자(31％)발생심도취정주요원인위대량실혈. 결론 술중심도취정여술전환자ECG결혈성개변상관.환자술전저혈홍단백농도화고ASA분급시술중심도취정환자난이복소적위험인소.
Objective To retrospectively investigate the risk factors affecting the outcome of resuscitation after intraoperative cardiac arrest in our hospital. Methods Medical records of patients experiencing intraoperative cardiac arrest in noncardiac surgery between January,2005 and December,2009 were reviewed. Results 48 164 patients of noncardiac surgical procedures were identified.There were 16 patients who occurred intraoperative cardiac arrest and the incidence was 3.32/10 000.Immediate survival rate after resuscitation was 9/16 (56％).There were no significant difference in age,gender,weight,and hemodynamic status of patients before the surgery on successful resuscitation.The preoperative hemoglobin concentration was lower in patients with successful resuscitation (115±30) g/L than those with unsuccessful resuscitation [(133±17) g/L,P＜0.05].The pre-operation ASA physical status (ASA PS) in the patients with successful resuscitation was higher compared to unsuccessful resuscitation (P＜0.05).Survival rate was significantly higher in patients with ASA PS of Ⅰ or Ⅱ compared to those with ASA PS of Ⅲ or higher.Preoperative blood glucose value and ST-T segment changes in electrocardiogram (ECG) didn't differ between two groups (P＞0.05).And the methods of anesthesia had no effects on the survival rate.Among 16 patients with cardiac arrest,12 patients (75％) had preoperative ischemic ECG changes and 5 patients (31％) had massive blood loss. Conclusions Intraoperative cardiac arrest was related to preoperative ischemic ECG changes.Lower preoperative hemoglobin concentration and higher ASA PS could be the risk factors for the death of patients with intraoperative cardiac arrest.