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中华重症医学电子杂志 ›› 2026, Vol. 12 ›› Issue (02) : 208 -213. doi: 10.3877/cma.j.issn.2096-1537.2026.02.019

综述

围手术期难治性心室颤动的研究进展
巩超, 许红娇, 黄丽娜, 李金宝()   
  1. 200080 上海,上海交通大学医学院附属第一人民医院麻醉科
  • 收稿日期:2025-08-05 出版日期:2026-05-28
  • 通信作者: 李金宝

Research progress of perioperative refractory ventricular fibrillation

Chao Gong, Hongjiao Xu, Lina Huang, Jinbao Li()   

  1. Department of Anesthesiology, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
  • Received:2025-08-05 Published:2026-05-28
  • Corresponding author: Jinbao Li
引用本文:

巩超, 许红娇, 黄丽娜, 李金宝. 围手术期难治性心室颤动的研究进展[J/OL]. 中华重症医学电子杂志, 2026, 12(02): 208-213.

Chao Gong, Hongjiao Xu, Lina Huang, Jinbao Li. Research progress of perioperative refractory ventricular fibrillation[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2026, 12(02): 208-213.

围手术期难治性心室颤动(RVF)特指发生于手术开始至术后24 h高危窗口期内,经规范心肺复苏(CPR)及多次除颤后仍持续存在的室性颤动。该病病死率极高(85%~97%),神经功能完好存活率极低(仅5.6%)。目前其围手术期专属流行病学数据尚待完善,作为围手术期心搏骤停的一种表现形式,其发生率为(4.3~5.8)/万,且在急诊手术、婴幼儿及高龄患者中风险显著增加。主要危险因素涵盖冠状动脉(简称冠脉)异常、合并心力衰竭或呼吸衰竭,以及心脏手术相关的再灌注损伤等。其病理生理机制涉及心肌电生理紊乱、代谢失衡与交感风暴的协同作用。防治关键在于实施阶梯式干预并快速启动多学科协作流程,包括:迅速启动高质量机械CPR联合双序贯除颤(DSED),早期识别无脉性电活动(PEA)作为复苏决策的关键节点;合理应用抗心律失常药物;尽早启动静脉-动脉体外膜氧合(VA-ECMO)支持,并转运至杂交手术室行冠脉造影/经皮冠脉介入治疗(PCI)等。本综述系统阐述围手术期RVF的定义、流行病学特征、高危因素、病理生理机制、当前治疗原则及研究进展,旨在为临床实践提供理论参考。

Perioperative refractory ventricular fibrillation (RVF) refers to ventricular fibrillation that persists after standard cardiopulmonary resuscitation and multiple defibrillations, occurring within the high-risk window from the start of surgery to 24 hours postoperatively. The mortality rate is extremely high (85%-97%) and the rate of survival with intact neurological function is very low (only 5.6%). Currently, the specific epidemiological data for this condition is still lacking. As a manifestation of perioperative cardiac arrest, its incidence is (4.3-5.8) per 10, 000 cases, with significantly increased risk in emergency surgeries, infants, and elderly patients. The main risk factors include coronary artery abnormalities, concomitant heart failure or respiratory failure, and reperfusion injury related to cardiac surgery. The pathophysiological mechanism involves the synergistic effects of myocardial electrophysiological disorders, metabolic imbalance, and sympathetic storm. The key to prevention and treatment lies in implementing a stepwise intervention approach and initiating a rapid multidisciplinary collaboration process, including: promptly initiating high-quality mechanical CPR combined with dual sequential defibrillation (DSED), early identification of pulseless electrical activity (PEA) as a critical decision-making node for resuscitation; rational use of anti-arrhythmic drugs; early initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support, and transfer to the hybrid operating room for coronary angiography/percutaneous coronary intervention (PCI), etc. This review systematically elaborates on the definition, epidemiological characteristics, risk factors, pathophysiological mechanism, current treatment principles, and research progress of perioperative RVF, aiming to provide a theoretical references for clinical practice.

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