Chufarov V N
Anesteziol Reanimatol. 1998 Mar-Apr(2):73-5.
Analysis of case histories of patients operated on in 1965-1995 is presented. Ventricular fibrillation or asystole was observed in 3.34ë 1.1% of 480 patients subjected to closed mitral commissurotomy and in 6.25ë 1.1% of 98 ones subjected to cardiopulmonary bypass surgery for replacing mitral valves. The incidence of complications directly correlated with the stage of mitral valvular disease and reoperations and inversely with monitoring of hemodynamics, blood gases, etc. Examination of the myocardium before the development of ventricular fibrillation or asystole most often revealed 1) myocardial ischemia of different degree and localization; 2) changed stimulation and conduction of the myocardium; 3) total myocardial hypoxia; 4) electric current action in cases with diathermal coagulation of vessels and/or poor grounding of devices; 5) injection of potent drugs, etc. Electromechanical dissociation of ventricular myocardium was observed in 6 patients. Sudden heart arrest was not caused by blocking of the bloodflow in any of the cases. Thus, some signs can be regarded as predicting the risk of sudden arrest of circulation. Monitoring of the functions of the body helps timely detect these signs. If ventricular fibrillation developed, defibrillation was carried out immediately.
本文呈现了对1965年至1995年接受手术治疗患者病历的分析。在480例行闭式二尖瓣交界切开术的患者中，3.34%±1.1%出现心室颤动或心搏停止；在98例行二尖瓣置换体外循环手术的患者中，6.25%±1.1%出现上述情况。并发症的发生率与二尖瓣疾病的阶段及再次手术直接相关，而与血流动力学、血气等监测情况呈负相关。在心室颤动或心搏停止发生前对心肌进行检查，最常发现：1）不同程度和部位的心肌缺血；2）心肌刺激和传导改变；3）心肌全面缺氧；4）血管电凝或设备接地不良时的电流作用；5）注射强效药物等。6例患者观察到心室心肌电机械分离。在任何病例中，心脏骤停均非由血流阻断所致。因此，某些体征可被视为循环突然停止风险的预测指标。对身体功能的监测有助于及时发现这些体征。若发生心室颤动，立即进行除颤。
