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題 名 | 麻醉中心臟突停(突死)--附十二病例報告=Cardiac Arrest During Anesthesia and Surgery with Report of 12 Cases |
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作 者 | 王學仕; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 2:3 民58.09 |
頁 次 | 頁106-116 |
關鍵詞 | |
語 文 | 中文(Chinese) |
中文摘要 | 1.關於心臟突停之簡史,診斷,預防及現代之治療方法,本篇曾作一綜合之報告。 2.從1960年Kouwenhoven, Jude及Knicker bocker三月在J.A.M.A.上發表過體外心臟按摩術(Closed Chest Cardiac Massage)一文後,使心臟急救術有了劃時代之改進。 3.臺灣榮民總醫院由四十八年至五十八年(1959 -- 1969)十年中,共有麻醉病例為19,002,其中發生心臟突停者有12病例(1:1584)。在此12例中,有7例救活而康復,救活率為59.3%。有兩例心臟突停之發生,與麻醉無關。 4.麻醉中之心臟突停,多由「大意」及「無知 」所造成。呼吸阻塞及麻醉劑過量為其兩大主因。所謂大意,乃措施行麻醉者過度自信,而實際上並未遵守麻醉中之各基本原則。所謂「無知」,乃指調派在麻醉科實習見習之工作人員,雖知其一,但不知其二,常僅分毫之差,而致生死之別。施行麻醉者在施行麻醉時應小心謹慎,麻醉工作人員之嚴格訓練,實為預防突死發生之最有效方法。 5.五"A"急救常規:美國心臟學會公佈之急救條例,雖甚理想,然由A--I,仍覺複雜,初學者常易混亂,且臨時不知從何下手,比五"A"常規,便於記憶,在施行急救時可能有所幫助,其五A如下:A:Artificial Ventilation (人工呼吸):口對口,口對鼻等。A:Artificial Circulation (人工循環):體外心臟按摩。A:Adrenaline Injection (注射腎上腺素)(1:1000) 1 mgm. I.V.或I.C. A: Antiacid Therapy (抗酸中毒):Sod. Bicarbonate 3.75 gm./50C.C. I.V. A: Antiarrhythmic treatment (抗心律不整治療):Xylocaine 1 - 2 mg/kg. I.V. 6.急救:顧名思義,首重迅速,手術中確有很多特殊設計之電化器械,惜多過於複維,常不能配合救急之需耍。經過「訓練之手」(Educated Hands),常為最神速最有效之急救「工具」。注意!你(急救者)的手,可代替的人之心臟,你的口,可代替病人之肺臟,你的明智之判斷,迅速之治療,可使一在死亡線上爭扎之垂危生命,又能生龍活虎再回到這充滿光明的人間。 |
英文摘要 | 1.Cardiac arrest is defined by Dr. P. Safar as "the clinical picture of sudden cessation of circulation in a patient who was not expected to dic at thc time." It can and does occur before anesthesia, during induction, and postoperatively. Cardiopulmonary resuscitation has saved and will save many lives and the personal conviction of the necessity for prompt diagnosis and immediate effective action is the key to success. 2. A series of 12 cases of cardiac arrest experienced during the past 10 years from 1959-1969 at Taiwan Veterans General Hospital are presented. The two main causes are anoxia due to air way obstruction and overdose of anesthetics due to errors in technical management. The total anesthetic admission was 19,002 cases and the incidence of cardiac arrest was 1: 1584 (0.06%). 3. Among the 12 cases of cardiac arrest, one case was due to massive bleeding during operation and the other one was due to air embolism during blood transfusion. Six cases encountered before 1960 and for whom open chest cardiac massage were performed and there were only 2 cases saved. From 1960 to 1969, there were another 6 cases of cardiac arrest and for whom closed chest cardiac massage were used instead and 5 of them were saved. Even in our small series of cases, it shows quite definitely that the closed chest cardiac massage is more effective than the open method. The survival rate in this series was 59.3%. 4. The recent literatures and current management of cardiopulmonary resuscitation have been reviewed and evaluated. In handling such emergencics, the complete gamut of resuscitation-A, B, C, D- should be adopted as early as possible. Planning is essential to success. Remember, you are the lungs and heart of thc patient. You may save him from being either clinical death or biological death. You may help him to see tomorrow. You must know what to do and must do it immediately. |
本系統中英文摘要資訊取自各篇刊載內容。