胸外科手术病人围麻醉期不良事件的回顾性分析  

A restrospective analysis of adverse events during peri-anesthesia period in patients scheduled for thoracic surgery

作　　者：徐美英[1] 张晓峰[1] 吴德华[1] 吴东进[1] 吴镜湘[1] 

机构地区：[1]上海交通大学附属胸科医院麻醉科,200030

出　　处：《中华麻醉学杂志》2014年第9期1037-1040,共4页Chinese Journal of Anesthesiology

基　　金：上海市级医院适宜技术联合开发推广应用项目（SHDC12010222）

摘　　要：本院2006年8月至2011年6月连续胸外科手术18 294例病人中,围麻醉期发生不良事件41例,其发生率0.224％,其中可预测及不可预测事件的构成比分别为15％、85％,临床类型主要为心跳骤停和大出血,构成比分别为37％、24％;不良事件诱因构成比分别为病人因素12.2％、手术因素48.8％、麻醉因素12.2％、病人-手术因素7.3％、病人-麻醉因素7.3％和病人-手术-麻醉因素12.2％;不良事件转归死亡比例17％（7例）,转归死亡的不良事件诱因构成比分别为手术因素43％、病人-手术因素43％、病人-手术-麻醉因素14％.气管手术病人不良事件的发生率（1.093％）高于肺部手术（0.223％）、纵隔手术（0.236％）和食管手术（0.194％）（P＜0.05）.综上所述,胸外科手术围麻醉期不良事件虽然是小概率事件,但均危及病人的生命安全.手术因素不仅是不良事件的主要诱因,而且还是导致病人死亡的危险因素,其诱发的不良事件临床上主要表现为心跳骤停和大出血,对于心跳骤停,只要及时发现、规范处理就能避免严重后果,对大出血则尤其值得重视,它是导致死亡的主要原因,其防治有赖于外科医生诊治水平.病人因素诱发的不良事件较难预测,密切监测是关键;麻醉因素主要是气道管理不善,需要重视术前气道评估.From August 2006 to June 2011 among consecutive 18 294 patients underwent thoracic surgery from Shanghai Chest Hospital, 4i developed adverse events during peri-anesthesia period and the incidence was 0.224%, and the constituent ratios of the predictable and unpredictable events were 15% and 85%, respectively. Cardiac arrest and massive hemorrhage were the main clinical manifestation of the adverse events and the constituent ratios were 37% and 24%, respectively. Among the inducements for adverse events, patient＇s factor, surgical factor, anesthesia factor, patient-surgery factor, patient-anesthesia factor and patient-surgery-anesthesia factor accounted for 12.2% , 48.8% , 12.2% , 7.3% , 7.3% and 12.2% , respectively. The ratio of death from adverse events was 17% （7 eases）, and among the inducements for adverse events causing death, surgical factor, patient-surgery factor and patient-surgery-anesthesia factor accounted for 43%, 43% and 14%, respectively. The incidence of adverse events was 1. 093 % in the patients underwent operation on trachea, which was significantly higher than that in the patients underwent operation on lung （0. 223 % ）, mediastinum （0. 236 % ） and esophagus （0. 194%）. In conclusion, although the adverse events which occurred during peri-anesthesia period in the patients underwent th0raeic surgery were rare, they threatened the safety of patients. Surgical factor was not only the main inducement, but also the risk factor for death, and cardiac arrest and massive hemorrhage were the main clinical manifestation of the surgery-related adverse events＂ For cardiac arrest, as long as it was found in time and treated appropriately, the serious consequences could be avoided. For massive hemorrhage, more attention should be paid due to be the main reason of death, and the prevention depended on the surgeon＇ s improvement of diagnosis and surgery. It was difficult to predict patient-related the adverse events and careful monitoring was required. For the anesthesia-related adverse

关 键 词：胸外科手术 麻醉 手术中并发症 手术后并发症 

分 类 号：R614[医药卫生—麻醉学]