围术期心搏骤停 - 麻醉相关心搏骤停及相关死亡率的亚分析。

Perioperative cardiac arrests - A subanalysis of the anesthesia -related cardiac arrests and associated mortality.

机构信息

Department of Anesthesiology, Emergency and Intensive Care, Centro Hospitalar do Porto, Largo Abel Salazar, 4099-001 Porto, Portugal.

Institute of Biomedical Science of Abel Salazar, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal.

出版信息

J Clin Anesth. 2018 Nov;50:78-90. doi: 10.1016/j.jclinane.2018.06.005. Epub 2018 Jul 11.

DOI:10.1016/j.jclinane.2018.06.005

PMID:30005296

Abstract

STUDY OBJECTIVE

To determine the incidence, risk factors, and predictors of survival of perioperative cardiac arrests (PCAs) occurring in patients who underwent non-cardiac and non-obstetric surgery from January 2008 to May 2015 at a tertiary hospital; determine the incidence and risk factors of anesthesia-related PCA.

DESIGN

Retrospective observational study.

SETTING

Operating room and postoperative recovery area.

PATIENTS

Sixty-two PCA cases from an anesthesia database of 122,289 anesthetics.

INTERVENTIONS

Each PCA was classified as anesthesia-related, partially anesthesia-related, or anesthesia unrelated. The main outcome variables were occurrence of PCA, survival at least 1 h after initial resuscitation and survival to hospital discharge. To determine the risk factors for PCA, for each patient who suffered a PCA, two other patients that underwent anesthesia on the same day and in the same operating suite were selected.

MEASUREMENTS

Three sets of variables were collected; patient-related, surgical procedure-related, and PCA-related.

MAIN RESULTS

The incidence of PCAs of all causes was 5.07 per 10,000 anesthetics, and the associated mortality was 2.9 per 10,000 anesthetics. The independent risk factors for occurrence were: ASA PS score higher than 3, diagnosed cardiac disease, and the use of vasopressors. Decreased survival was associated with: higher ASA PS score, urgent surgical procedures of a higher complexity, use of vasopressors, documented hypotension prior to PCA, and arrests due to bleeding. The incidence of anesthesia-related PCAs was 0.74 per 10,000 anesthetics, and the associated mortality was 0.08 per 10,000 anesthetics. The main causes of anesthesia-related PCAs were associated with medication and airway/ventilation, and the independent risk factors for occurrence were: ASA PS score higher than 3 and diagnosed cardiac disease.

CONCLUSIONS

Most PCAs were not due to anesthesia-related causes, and anesthesia-related PCAs were associated with improved survival. Improvements in the management of high-risk patients, medication administration, and airway/ventilation management may result in better outcomes.

摘要

研究目的

确定 2008 年 1 月至 2015 年 5 月期间在一家三级医院接受非心脏和非产科手术的患者围手术期心脏骤停（PCA）的发生率、危险因素和生存预测因素；确定与麻醉相关的 PCA 的发生率和危险因素。

设计

回顾性观察性研究。

地点

手术室和术后恢复区。

患者

来自 122289 例麻醉数据库的 62 例 PCA 病例。

干预措施

每次 PCA 均分为与麻醉相关、部分与麻醉相关或与麻醉无关。主要观察变量为 PCA 的发生、初始复苏后至少 1 小时的生存和出院时的生存。为了确定 PCA 的危险因素，对于每个发生 PCA 的患者，选择同一天和同一手术室接受麻醉的另外两名患者。

测量

收集了三组变量；患者相关、手术相关和 PCA 相关。

主要结果

所有原因导致的 PCA 发生率为每 10000 例麻醉 5.07 例，相关死亡率为每 10000 例麻醉 2.9 例。发生的独立危险因素为：ASA PS 评分>3、诊断性心脏病和使用血管加压药。生存下降与：较高的 ASA PS 评分、更高复杂性的紧急手术、血管加压药的使用、PCA 前记录的低血压以及出血引起的骤停有关。与麻醉相关的 PCA 发生率为每 10000 例麻醉 0.74 例，相关死亡率为每 10000 例麻醉 0.08 例。与麻醉相关的 PCA 的主要原因与药物和气道/通气有关，发生的独立危险因素为：ASA PS 评分>3 和诊断性心脏病。