围术期心跳骤停13例分析

对围术期心跳骤停的 13例回顾分析如下。1　临床资料我院 1980～ 2 0 0 1年共施行各类手术 5 0 4 4 8例 ,发生心跳骤停 13例 ,总发生率为 1∶ 3880。抢救无效死亡 3例 ,总死亡率为1∶ 16 816 ,其中 1980～ 1993年手术 314 17例 ,心跳骤停 12例 ,发生率为 1∶ 2 6 18,1994～ 2 0 0 1年手术 190 31例 ,心跳骤停 1例。 13例中经抢救心肺脑复苏成功 7例 (5 3.8% ) ,死亡 3例(2 3.1% ) ,植物状态 3例 (2 3.1% )。复苏成功的 7例中 ,死于手术并发症 3例 (2 3.1% ) ,痊愈出院 4例 (30 .8% )。分类 :1按麻醉分类 :全麻 6例 ,硬膜外阻滞 6例 ,局麻 1…     

围手术期循环骤停原因分析

循环骤停是围手术期最可怕的事件，亦是麻醉医生最关注和置于第一位的问题。复习临床麻醉学杂志和中华麻醉学杂志（简称“两刊”），自1990-2000年间报告或涉及围手术期循环骤停文章135篇，计419例，兹就其原因分析如下。     

麻醉或手术病人意外心跳骤停四例分析

我院自1985年以来，麻醉或手术病人发生意外心跳骤停4例，经抢救成功3例，死亡1例。现报道如下。[例1]男性，54岁，上中腹部闷痛、纳差4月，黑便15天，于1985年8月15日入院。无心脏病史。查体：BP12／skPa，消瘦，贫血貌，心肺正常，X线胸片与心电图无异常，Hb809／L，纤维胃镜     

手术中心跳骤停5例分析

我院 198 9- 0 2～ 1994- 0 8在手术中发生心跳骤停 5例 ,经复苏抢救 2例痊愈 ,1例术后 4d死亡 ,2例术中死亡 ,现报告如下。1　病例报告例 1　女 ,78岁。ASA 级 ,直肠癌根治术。硬膜外麻醉用1.33%利多卡因 30 ml,麻醉平面 T6 ～ S5,BP145 / 85 mm Hg,P84次 / min,R18次 / min。开腹时有痛感 ,静注安定 10 mg,哌替啶 5 0 mg仍叫痛。从硬膜外注 2 %利多卡因 10 ml,5 min后血压剧降至 90 / 6 0 mm Hg,用多巴胺升压 ,手触颈动脉有心律不齐 ,疑有低血钾 ,将氯化钾 0 .45 g加入平衡液 10 0 ml静滴 ,心律恢复正常。手术完成关腹时肌紧再次用 2…     

心内直视手术后早期心跳骤停危险因素的预测及急救

分析了１２例行心内直视手术后２４ｈ内发生心跳骤停的患者。认为１．严重的心律失常，如多源性室性早搏，尤其是ＲｏｎＴ现象以及室性心动过速是导致心跳骤停的主要原因；２．缺氧、低血钾及其他意外是常见的诱发因素；３．各种抢救药品、物品、器械齐全是抢救成功的前提；４．良好的群体素质，准确、快速有效地现场抢救是成功的关键     

住院患儿发生心跳呼吸骤停的死亡危险因素分析

目的探讨发生心跳呼吸骤停（CRA）住院儿童的死亡危险因素。方法回顾性分析2006年1月至2008年12月入住烟台毓璜顶医院儿童重症监护室（PICU）的CRA的87例患儿临床及心肺复苏（CPR）资料,并进行单因素分析以及多因素非条件Logistic回归分析,分析影响死亡率的危险因素。结果2006年1月至2008年12月人住烟台毓璜顶医院PICU发生CRA的87例患儿实施CRP,45例未恢复自主循环,初步死亡率为51．7％。单因素分析结果显示：年龄、原发病、血气分析、合并症以及发生CRA至CPR开始的时间（TCRA-CPR）、CRA发生时有无气管插管、应用肾上腺素的剂量、CPR持续时间（TCPR）与死亡率有关,Logistic回归分析示TCRA-CPR、TCPR为影响死亡率的独立危险因素。结论住院患儿发生CRA后死亡率较高,年龄、原发病及合并症、动脉血气及CPR质量影响死亡率,其中TCRA—CPR、TCPR为独立危险因素。     

胆囊摘除术前心跳骤停25分钟成功复苏1例

患者 ,女 ,49岁 ,体重 65kg ,因胆囊结石 ,拟在硬膜外麻醉下行胆囊摘除术。术前检查资料 :ECG示窦性心率 ,偶发室性早搏 ;心脏彩超示小量心包积液 ;余无特殊发现。术前半小时肌注阿托品 0 5mg ,鲁米那 0 1g。患者入室血压 10 6/ 60mmHg ,心率 70次 /min ,未吸O2 时SpO293 %。行T9,10 间隙穿刺 ,成功后给试探量 ,确认无腰麻征象后 ,分两次追加诱导量利 -丁混合液共 8mL。 15min后麻醉平面固定在T4～ 12 水平。面罩吸O2 时SpO2 >96% ,心率、血压无明显波动。诱导半小时后依次静注杜冷丁 5 0mg ,咪唑安定 5mg。患者出现鼾声 ,SpO2 开始…     

术中突发心跳骤停抢救护理体会

术中突发心跳骤停抢救护理体会５５０００１贵阳医学院附院姚莉心跳骤停是麻醉和手术中最严重的并发症。该患儿术中突发心跳骤停约５分钟，经医护紧密配合，抢救成功，５分钟患儿心跳恢复，现就术中抢救体会介绍如下。一、病例介绍患儿，男，５岁，因意外枪弹伤，一月前，...     

创伤性心跳骤停预后因素分析及其对策

目的 分析创伤性心跳骤停预后因素,总结复苏成功经验。方法 应用回顾性分析方法对本院近两年来创伤性心跳骤停病人各因素和出院存活率进行分析。结果 两年来共收治创伤性心跳骤停病人74例,存活率为6.75％;院内与院外心跳骤停存活率无差别,室颤比心电静止存活率高。立即复苏组比未立即复苏组存活率高,存活组受伤至心跳骤停时间比死亡组长,存活5例在立即进行心肺复苏同时还针对病因进行手术治疗。结论 创伤性心跳骤停复苏存活率总体水平不高,心跳骤停发生地点与存活率没有明显关系,但室颤、心跳骤停发生时间晚、早期复苏、积极处理病因者存活可能性大。     

50例心跳呼吸骤停病人心肺复苏的分析

目的：探讨心跳呼吸骤停病人抢救的临床经验，提高心肺复苏的成功率。方法：回顾性分析我院2006-2007年急诊抢救的50例心跳呼吸骤停病人的临床资料，通过分析影响心肺复苏的因素以提高心肺复苏的成功率。结果：50例中初步心肺复苏的12例，最终康复出院的6例。结论：心肺复苏的成功率与该患者的原发病，心跳呼吸骤停时间，CPR的及时正确，电除颤的及时准确使用，及早气管插管以及脑复苏的正确及时实施有相关性。另外碳酸氢钠及大剂量的肾上腺素使用可提高成功率。     

围术期非心脏手术呼吸心搏骤停相关麻醉因素回顾性分析

目的回顾性分析聊城市人民医院近7年来,围术期24 h内发生心搏骤停患者的医学资料,为预防这一严重不良事件提供有益信息。方法通过我院手术麻醉电子系统,调阅不良事件上报系统,选取2013-07/2020-12期间在我院手术室接受非心脏手术围术期发生心搏骤停患者的医疗记录进行分析、归纳总结。结果共116152名患者接受非心脏手术麻醉,围术期发生心搏骤停33例(2.8/10000),21例复苏失败,死亡率1.8/10000。麻醉完全相关2例,麻醉部分相关12例,麻醉相关心搏骤停发生率1.2/10000。与麻醉不相关心搏骤停患者基本资料比较,差异无统计学意义。结论围术期心搏骤停原因复杂多样,失血性休克以及感染性休克,是围术期心搏骤停最常见的原因,麻醉医生应熟知各种不同类型心搏骤停病理生理机制,以便实施快速有效的抢救措施。     

护理干预用于恶性心律失常致心脏骤停患者中的效果评价

目的探究护理干预用于恶性心律失常致心脏骤停患者中的效果。方法选取恶性心律失常致心脏骤停患者83例,按随机数字表法分为观察组(42例)与对照组(41例),对照组患者给予常规护理干预,观察组患者给予常规护理干预并加强相关护理操作及其管理。观察并比较2组患者的抢救情况、生存质量以及相关生命体征指标恢复时间。结果观察组的抢救初步成功率、抢救完全成功率以及生存质量总得分均高于对照组;观察组的自主呼吸恢复时间、自主循环恢复时间、窦性心律恢复时间均低于对照组,差异具有统计学意义(P0.05)。结论加强相关护理操作及其管理等护理干预措施能够有效促进恶性心律失常致心脏骤停患者呼吸、心律等恢复正常,提高患者抢救成功率及其生存质量。     

心脏起搏器植入术围术期预防性抗菌药物使用分析及围术期护理体会

目的分析本院心脏起搏器植入术围术期预防性抗菌药物使用情况以及在使用过程中存在的问题。方法对125例心脏起搏器植入术围术期预防性抗菌药物使用情况进行回顾性调查分析。结果使用的抗菌药物涉及头孢菌素类、青霉素类、喹诺酮类以及林可霉素类4大类,其中抗菌使用率最高的是头孢呋辛,占55.2%,其次是头孢美唑,占21.6%;抗菌药物用量最多的是头孢呋辛,其次为头孢美唑钠;平均用药时间(3.2±1.3)d;术后有1例感染,给予头孢呋辛抗感染,并及时将切口处消毒换药处理,术后第9天拆线出院。结论本院心脏起搏器植入术围术期预防性抗菌药物选择给药方面较为合理,但仍存在一定比例的不合理用药,并且还存在用药量过大及用药时间过长的问题,因此还需进一步加强管理,坚决将不合理用药使用率最大化降低。     

Adherence to CPR guidelines during perioperative cardiac arrest in a developing country

BACKGROUND AND GOAL OF STUDY: Cardiopulmonary resuscitation (CPR) is an integral part of anaesthetic training. In Nigeria, these skills are taught mainly during medical school and postgraduate training. International guidelines were introduced in 2000 and new guidelines were produced in November 2005. The study sought to assess how closely anaesthetists in a Nigerian teaching hospital abide by the 2000 guidelines. MATERIALS AND METHODS: All perioperative cardiac arrests in adults that occurred in a 1-year-period were studied prospectively. All patients <15 years and cardiac arrests occurring outside the direct supervision of the anaesthetists were excluded. Time and duration of arrest, cardiac arrest rhythm and management were documented along with immediate outcome. RESULTS: Thirteen cardiac arrests occurred in 2147 perioperative cases (incidence: 6/1000). Seven patients had non ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) rhythms. The mean age of patients was 30.23+/-11.06 years. Orotracheal intubation, manual ventilation with 100% O(2) and external chest compressions were instituted in all cases. The mean duration of arrest was 25.66+/-13.34 min. All patients received adrenaline (epinephrine) and atropine. The median interval between adrenaline doses was 7.5 min. Only one cycle of defibrillation was given to patients in VF/VT. Immediate survival occurred in five patients (38.46%). CONCLUSION: Anaesthetists in our hospital are not applying proper resuscitation guidelines. The lack of organised simulation practice resulted in deficient knowledge and skills. There is a need for continuing training in basic and advanced resuscitation for all anaesthetists according to the guidelines.     

识别高危风险因素，做好老年髋部损伤的围手术期护理

目的 探讨老年髋部损伤患者围手术期的高危风险因素，做好患者围手术护理工作。方法 对我院自1991年-1999年收治的172例髋部损伤的患者进行回顾性调查，对调查结果进行多元回归分析比较，并进行统计检查。结果 老年髋部损伤患者发生并发症的患者中，伤前活动能力差，血色素及总蛋白较低，有较大的手术风险，围手术期针对性预防护理有意义。结论 在老年髋部损伤的围手术期护理中，注意识别高危风险因素，有效预防并发症的发生，提高护理质量。     

In-hospital cardiac arrest

In-hospital sudden cardiac arrest and resuscitation is distinct from out-of-hospital sudden cardiac arrest (OOHSCA) and warrants specific attention. Sudden cardiac arrest (SCA) is a manifestation of an underlying process rather than a disease itself. The complex, multiorgan system dysfunction common among the inpatient population can precipitate SCA by both similar and very different mechanisms than OOHSCA. The diagnostic and treatment algorithms of SCA remain largely the same between the inpatient and outpatient arenas. The application of complex diagnostic and therapeutic interventions is permissible, but such tools must not interrupt or delay the important basics of cardiac arrest management in the inpatient setting, including adequate chest compressions and timely defibrillation when appropriate.     

In-hospital cardiac arrest: incidence,prognosis and possible measures to improve survival

Design Review. Objective Medical literature on in-hospital cardiac arrest (IHCA) was reviewed to summarise: (a) the incidence of and survival after IHCA, (b) major prognostic factors, (c) possible interventions to improve survival. Results and conclusions The incidence of IHCA is rarely reported in the literature. Values range between 1 and 5 events per 1,000 hospital admissions, or 0.175 events/bed annually. Reported survival to hospital discharge varies from 0% to 42%, the most common range being between 15% and 20%. Pre-arrest prognostic factors: the prognostic value of age is controversial. Among comorbidities, sepsis, cancer, renal failure and homebound lifestyle are significantly associated with poor survival. However, pre-arrest morbidity scores have not yet been prospectively validated as instruments to predict failure to survive after IHCA. Intra-arrest factors: ventricular fibrillation/ventricular tachycardia (VF/VT) as the first recorded rhythm and a shorter interval between IHCA and cardiopulmonary resuscitation or defibrillation are associated with higher survival. However, VF/VT is present in only 25–35% of IHCAs. Short-term survival is also higher in patients resuscitated with chest compression rates above 80/min. Interventions likely to improve survival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation. Mild therapeutic hypothermia is effective as post-arrest treatment of out-of-hospital cardiac arrest due to VF/VT, but its benefit after IHCA and after cardiac arrest with non-VF/VT rhythms has not been clearly demonstrated.     

The relationship between age and outcome in out-of-hospital cardiac arrest patients

AimTo determine the association between age and outcome in a large multicenter cohort of out-of-hospital cardiac arrest patients.MethodsRetrospective, observational, cohort study of out-of-hospital cardiac arrest from the CARES registry between 2006 and 2013. Age was categorized into 5-year intervals and the association between age group and outcomes (return of spontaneous circulation (ROSC), survival and good neurological outcome) was assessed in univariable and multivariable analysis. We performed a subgroup analysis in patients who had return of spontaneous circulation.ResultsA total of 101,968 people were included. The median age was 66 years (quartiles: 54, 78) and 39% were female. 31,236 (30.6%) of the included patients had sustained ROSC, 9761 (9.6%) survived to hospital discharge and 8058 (7.9%) survived with a good neurological outcome. The proportion of patients with ROSC was highest in those with age <20 years (34.1%) and lowest in those with age 95–99 years (23.5%). Patients with age <20 years had the highest proportion of survival (16.7%) and good neurological outcome (14.8%) whereas those with age 95–99 years had the lowest proportion of survival (1.7%) and good neurological outcome (1.2%). In the full cohort and in the patients with ROSC there appeared to be a progressive decline in survival and good neurological outcome after the age of approximately 45–64 years. Age alone was not a good predictor of outcome.ConclusionsAdvanced age is associated with outcomes in out-of-hospital cardiac arrest. We did not identify a specific age threshold beyond which the chance of a meaningful recovery was excluded.     

255例院前心搏骤停患者心肺复苏影响因素分析

目的了解6年来心肺复苏(CPR)现状,分析其影响因素,研究如何提高CPR水平。方法对本院2001-01～2007-01院前发生的255例心搏骤停(cardiacarrest,CA)患者的资料进行分析,比较自主循环恢复(ROSC)成功组和失败组的CPR开始时间、CPR持续时间、除颤次数、肾上腺素用量等。结果全部病例ROSC成功率为38.03%,脑复苏成功率仅为2.74%。两组CPR开始时间(从心脏停搏至CPR开始时间)、人工气道开始建立时间、是否安装临时起搏器、肾上腺素用量比较差异有统计学意义(P≤0.01),在CPR持续时间、除颤次数方面比较差异无统计学意义(P>0.05)。CPR成功率与CPR开始时间和急救水平高低有密切关系。结论CA患者CPR成功率较低,与"生命链"未彻底落实及急救水平低有关。普及全民急救知识,加强完善急救医疗体系建设,是提高CPR成功率的关键措施。