小儿麻醉相关性心跳骤停：儿科围手术期心跳骤停登记处的知识更新  

作　　者：Sanjay M. Bhananker Chandra Ramamoorthy Jeremy M. Geiduschek Karen L. Posner Karen B. Domino Charles M. Haberkern John S. Campos leffrey P. Morray 邢军(译) 李成辉(校) 

机构地区：[1]Department of Anesthesiology, University of Washington, School of Medicine, Seattle, Washington [2]Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California [3]Department of Anesthesiology, Phoenix Children's Hospital and Valley Anesthesiology Consultants, Phoenix, Arizona [4]不详

出　　处：《麻醉与镇痛》2008年第4期31-38,共8页Anesthesia & Analgesia

摘　　要：背景小儿围手术期心跳骤停（POCA）登记处（1994至1997年14）最初的调查结果显示，药物相关性原因是小儿围手术期心跳骤停最常见的原因，例如氟烷B}起的心血管抑制。小儿麻醉技术的变化可能已经使麻醉过程中心跳骤停的原因发生了改变。方法有将近80个为小儿提供麻醉的北美医疗机构自愿加入POCA登记处。这些机构均以标准化数据表格的形式，将每一例≤18岁的小儿围手术期心跳骤停病例匿名上报。据此我们分析了1998至2004年麻醉相关性心跳骤停的原因和相关因素。结果从1998至2004年，有193例（49％）心跳骤停与麻醉相关，其中药物相关性心跳骤停占所有心跳骤停的18％。而1994至1997年期间为37％（P〈0．05）。心血管方面是最常见的原因（占41％），其中失血导致的低血容量和输入库存血导致的高钾血症是最常见的、可确定的心血管原因。导致心跳骤停的呼吸性原因（27％）中，喉痉挛导致的气道梗阻最为常见。中心静脉导管置入过程中引起的血管损伤是设备相关性心跳骤停的最常见原因。在麻醉的不同阶段心跳骤停的原因也存在差异（P〈0．01）。心血管和呼吸方面的原因分别是手术中和手术后阶段最常见的原因。结论伴随氟烷在小儿麻醉中使用减少，与氟烷引起的心血管抑制相关的心跳骤停发生比例降低。通过预防措施可以降低心跳骤停原因各个分类中最常见病因的发生率。BACKGROUND： The initial findings from the Pediatric Perioperative Cardiac Arrest （POCA） Registry （1994 - 1997） revealed that medication-related causes, often cardiovascular depression from halothane, were the most common. Changes in pediatric anesthesia practice may have altered the causes of cardiac arrest in anesthetized children. METH- ODS： Nearly 80 North American institutions that provide anesthesia for children voluntarily enrolled in the Pediatric Perioperative Cardiac Arrest Registry. A standardized data form for each perioperative cardiac arrest in children ≤ 18 yr of age was submitted anonymously. We analyzed causes of anesthesia-related cardiac arrests and related factors in 1998 -2004. RESULTS： From 1998 to 2004, 193 arrests （49%） were related to anesthesia. Medication-related arrests accounted for 18% of all arrests, compared with 37 % from 1994 to 1997 （P 〈 0.05）. Cardiovascular causes of .cardiac arrest were the most common （41% of all arrests）, with hypovolemia from blood loss and hyperkalemia from transfusion of stored blood the most common identifiable cardiovascular causes. Among respiratory causes of arrest （27%）, airway obstruction from laryngospasm was the most common cause. Vascular injury incurred during placement of central venous catheters was the most common equipmentrelated cause of arrest. The cause of arrest varied by phase of anesthesia care （P 〈 0.01 ）. Cardiovascular and respiratory causes occurred most commonly in the surgical and postsurgical phases, respectively. CONCLUSIONS： A reduction in the pro- portion of arrests related to cardiovascular depression due to halothane may be related to the declining use of halothane in pediatric anesthetic practice. The incidence of the most common remaining causes of arrest in each category may be reduced through preventive measures.

关 键 词：心跳骤停 小儿麻醉 围手术期 知识更新 心血管抑制 中心静脉导管置入 药物相关性 儿科 

分 类 号：R541.78[医药卫生—心血管疾病] R614[医药卫生—内科学]