心血管手术围术期循环骤停事件回顾分析

目的:回顾总结近9年心血管手术围术期循环骤停的发生原因、死亡率及心肺复苏相关经验。方法:发生循环骤停25例,比例为1.47/1000。其中室颤21例,室速2例,心脏停搏2例。用单、多因素分析可能导致循环骤停的原因。结果:导致25例循环骤停的原因:心肌缺血11例(44%),内环境紊乱4例(16%),缺氧3例(12%),急性心衰2例(8%),麻醉诱导不当致循环抑制2例(8%),其他3例(12%)。22例经心肺复苏(CPR)恢复有效自主循环,3例顽固性室颤于CPR同时紧急建立、运行体外循环。循环骤停患者术后死亡5例,死亡率为2.9/10000;与麻醉相关者2例,死亡率为1.17/10000。结论:心血管手术围术期循环骤停的病因主要归结于心肌供血、供氧不足,心律失常及内环境紊乱三方面失衡。于早期CPR同时紧急建立、运行体外循环可提高复苏后生存率。

A retrospective analysis of suddenly circulation arrest in patients during perioperative period of cardiovascular operation

Objective： To analyze the data of suddenly circulation arrest in patients during perioperative period of cardiovascular operation. Methods： A retrospectively analysis of data of twenty five cardiac arrest patients was carried out. Results： The cause of circulation arrest as follows： （1） myocardial ischemia, 11 cases （44%）; （2） internal environment disorder. 4 cases （16%）; （3） hypoxia, 3 cases （12%）; （4） acute heart failure, 2 cases （8%）; （5） circulation suppress by anesthesia, 2 cases （8%）; （6） other 3 cases （12%）. Twenty two patients recover their own effective circulation after cardio-pulmonary resuscitation, five patients died, mortality rate was 2.9/10000, two patients death were related to anesthesia （1.7/10000）. Conclusion： The cause of circulation arrest in patients during perioperative period of cardiovascular operation mainly is myocardium ischemia or anoxia, arrhythmia and internal environment disorder. Emergency extracorporeal circulation can obvious improved survival rate after CPR.