老年患者术中及麻醉相关心脏骤停及其死亡率：一家三级教学医院的15年调查
Intraoperative and anesthesia-related cardiac arrest and its mortality in older patients: a 15-year survey in a tertiary teaching hospital.
作者信息
Nunes Juscimar C, Braz Jose R C, Oliveira Thais S, de Carvalho Lidia R, Castiglia Yara M M, Braz Leandro G
机构信息
Department of Anesthesiology, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
Department of Biostatistics, Institute of Biosciences, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
出版信息
PLoS One. 2014 Aug 12;9(8):e104041. doi: 10.1371/journal.pone.0104041. eCollection 2014.
BACKGROUND
Little information is known about factors that influence perioperative and anesthesia-related cardiac arrest (CA) in older patients. This study evaluated the incidence, causes and outcome of intraoperative and anesthesia-related CA in older patients in a Brazilian teaching hospital between 1996 and 2010.
METHODS
During the study, older patients received 18,367 anesthetics. Data collected included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, anesthesia type, medical specialty team and outcome. All CAs were categorized by cause into one of four groups: patient's disease/condition-related, surgery-related, totally anesthesia-related or partially anesthesia-related.
RESULTS
All intraoperative CAs and deaths rates are shown per 10,000 anesthetics. There were 100 CAs (54.44; 95% confidence intervals [CI]: 44.68-64.20) and 68 deaths (37.02; 95% CI: 27.56-46.48). The majority of CAs were patient's disease-/condition-related (43.5; 95% CI: 13.44-73.68). There were six anesthesia-related CAs (3.26; 95% CI: 0.65-5.87) - 1 totally and 5 partially anesthesia-related, and three deaths, all partially anesthesia-related (1.63; 95% CI: 0.0-3.47). ASA I-II physical status patients presented no anesthesia-related CA. Anesthesia-related CA, absent in the last five years of the study, was due to medication-/airway-related causes. ASA physical status was the most important predictor of CA (odds ratio: 14.52; 95% CI: 4.48-47.08; P<0.001) followed by emergency surgery (odds ratio: 8.07; 95% CI: 5.14-12.68; P<0.001).
CONCLUSIONS
The study identified high incidence of intraoperative CAs with high mortality in older patients. The large majority of CAs were caused by factors not anesthesia-related. Anesthesia-related CA and mortality rates were 3.26 and 1.63 per 10,000 anesthetics, with no anesthesia-related CA in the last five years of the study. Major predictors of intraoperative CAs were poorer ASA physical status and emergency surgery. All anesthesia-related CAs were medication-related or airway-related, which is important for prevention strategies.
背景
关于影响老年患者围手术期及麻醉相关心脏骤停（CA）的因素，人们了解甚少。本研究评估了1996年至2010年期间巴西一家教学医院老年患者术中及麻醉相关CA的发生率、原因及转归。
方法
在研究期间，老年患者接受了18367次麻醉。收集的数据包括患者特征、手术操作、美国麻醉医师协会（ASA）身体状况、麻醉类型、医学专业团队及转归。所有CA按原因分为四组之一：患者疾病/状况相关、手术相关、完全麻醉相关或部分麻醉相关。
结果
所有术中CA及死亡率按每10000次麻醉显示。共有100例CA（54.44；95%置信区间[CI]：44.68 - 64.20）及68例死亡（37.02；95%CI：27.56 - 46.48）。大多数CA为患者疾病/状况相关（43.5；95%CI：13.44 - 73.68）。有6例麻醉相关CA（3.26；95%CI：0.65 - 5.87）——1例完全麻醉相关和5例部分麻醉相关，3例死亡，均为部分麻醉相关（1.63；95%CI：0.0 - 3.47）。ASA I-II身体状况的患者未出现麻醉相关CA。研究最后五年未出现麻醉相关CA，其原因是药物/气道相关。ASA身体状况是CA最重要的预测因素（比值比：14.52；95%CI：4.48 - 47.08；P<0.001），其次是急诊手术（比值比：8.07；95%CI：5.14 - 12.68；P<0.001）。
结论
该研究发现老年患者术中CA发生率高且死亡率高。绝大多数CA由非麻醉相关因素引起。麻醉相关CA及死亡率分别为每10000次麻醉3.26例和1.63例，研究最后五年未出现麻醉相关CA。术中CA的主要预测因素是较差的ASA身体状况及急诊手术。所有麻醉相关CA均为药物相关或气道相关，这对预防策略很重要。
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