PREOPERATIVE HEMORRHAGIC SHOCK AND INTRAOPERATIVE BLEEDING: TWO MAIN CAUSES OF SURGICAL DEATHS IN JAPAN
PREOPERATIVE HEMORRHAGIC SHOCK AND INTRAOPERATIVE BLEEDING: TWO MAIN CAUSES OF SURGICAL DEATHS IN JAPAN
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术前失血性休克和术中出血：日本手术死亡的两个主要原因
DOI：
10.3925/jjtc1958.51.23
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
T. Sawa
中科院分区：
文献类型：
--
作者：
Y. Kawashima;K. Irita;K. Morita;K. Tuzaki;T. Sawa
1999年至2002年，日本麻醉医师协会（JSA）麻醉相关危急事件监测小组委员会每年向所有JSA认证的培训医院（平均806家）发送机密调查问卷。每年以相同的形式收集数据，分析麻醉和手术期间心脏骤停和其他关键事件的发生率，以及术后7天内的结局。从问卷中的52个项目中选择每起重大事件的主要原因进行分析，4年共记录了4，297，066起事件，平均回复率为75.0%。术后7天内死亡2860例。死亡的两个主要原因是术前失血性休克和术中大出血（图2），分别占病例的32.8% [95% CI，p<0.05：31.0，34.6]和18.0% [15.1，20.8]（图3）。手术和麻醉期间心脏骤停的两个主要原因是术前失血性休克和术中大出血（图4）。为了减少日本手术室中危及生命的出血事件以及术后7天内的死亡率和发病率，需要分析围手术期出血的原因;导致死亡的序列;手术室人员配备水平的适当性;以及从血库到医院输血服务到手术室的血液供应系统的功能状态。
The Japanese Society of Anesthesiologists (JSA) Subcommittee on Surveillance of Anesthesiarelated Critical Incidents sent confidential questionnaires to all JSA Certified Training Hospitals (n=806 on average) every year from 1999 to 2002. Data collected in the identical forms each year were analyzed for incidence of cardiac arrest and other critical events during anesthesia and surgery, and for outcomes within 7 postoperative days. The principal cause of each critical incident selected from a list of 52 items provided on the questionnaires was also analyzed.With an average response rate of 75.0%, a total of 4, 297, 066 cases were documented over 4 years. A total of 2, 860 patients died within 7 postoperative days. The two principal causes of deaths were preoperative hemorrhagic shock and massive hemorrhage during surgery (Fig. 2), representing 32.8% [95% CI at p<0.05: 31.0, 34.6] and 18.0% [15.1, 20.8] of cases, respectively (Fig. 3). The two principal causes of cardiac arrest during surgery and anesthesia were valso preoperative hemorrhagic shock and massive hemorrhage during surgery (Fig. 4). To reduce life-threatening hemorrhagic events in the operating room and mortality and morbidity within 7 postoperative days in Japan, analysis is need of causes of perioperative bleeding; sequences leading to fatality; adequacy of staffing levels in the operating room; as well as the functional state of the blood supply system from a blood bank, through transfusion service of the hospital to the operating room.