江苏省基层医院围麻醉期危机状况的调查分析

Investigation of risk events during perianesthesia period in primary hospitals in Jiangsu province

目的调查江苏省基层医院围麻醉期手术患者遭遇危机状况的相关风险因素,为基层医院麻醉科医务人员识别患者的潜在危机、为提高麻醉期手术患者的安全意识提供参考。方法调查采取多阶段分层的整群随机抽样方法,从64家基层医院抽取100例遭遇危机状况的手术患者,资料采集方式为查阅病例档案和询问主治医生,调查指标涉及围麻醉期危机事件的患者人口学资料、术前检查与评估、麻醉实施与监护。结果遭遇危机状况的男性患者年龄为66[20]岁,手术类型以普外科、骨科和胸外科为主。女性患者年龄为56[33]岁,手术类型以产科、普外科和骨科为主,继之以妇科和胸外科。遭遇危机状况患者年龄段前3位是60~69岁、70~79岁和50~59岁。患者伴随疾病包括:高血压51.4%、糖尿病13.9%、脑梗死11.1%和冠心病5.6%。术前心功能评估有重要临床意义,包括从心电图获知心律和心率,从超声心动图获悉射血分数和肺动脉压。ASA分级情况:Ⅰ级患者占比14.0%、Ⅱ级45.2%、Ⅲ级30.1%和Ⅳ级10.8%,其中急诊患者占比21.5%。患者麻醉方法:全身麻醉87例、椎管内阻滞11例和周围神经阻滞2例。有创动脉血压监测供需比为88.6%,中心静脉置管供需比为107.1%。结论基层医院麻醉医生需要熟悉手术患者遭遇危机状况的年龄段分布和手术类型,熟悉伴随疾病并重点评估心功能,合理选择麻醉方法和使用诱导药物,积极建立有创血流动力学监测,以保障基层医院手术患者的生命安全和医疗质量。

Objective This study was aimed to investigate the risk events during the perianesthesia period in primary hospitals in Jiangsu province,in order to help anesthetists discern the underlying crisis and guarantee the safety of surgical patients in primary hospitals.Methods This investigation employed multi-stage stratified cluster random sampling method,and 100 cases of medical crises were selected from 64 primary hospitals in 2018~2020.The investigators collected information by reviewing medical records and interviewing with attending physicians.Demographic characteristics,preoperative evaluations,and anesthesia regimes of these cases were analyzed in detail.Results Male patients suffered various risks at a median age of 66[20]years,with general,orthopedic,and thoracic surgeries being the main surgical types.Female patients suffered diverse risks at a median age of 56[33]years,with obstetric,general,and orthopedic surgeries being the main surgical types,followed by gynecologic and thoracic surgeries.The patients suffered much more risk events in the 60~69,70~79,and 50~59 age groups,and they were most likely complicated with hypertension(51.4%),diabetes(13.9%),cerebral infarction(11.1%),and coronary disease(5.6%).Assessment of cardiac function was of great clinical significance,including the heart rate and rhythm assessed by electrocardiogram,and the ejecting fraction and pulmonary arterial pressure assessed by echocardiography.These patients showed physical statuses of American Society of Anesthesiologists(ASA)-Ⅱ(45.2%),ASA-Ⅲ(30.1%),ASA-Ⅰ(14.0%),and ASA-Ⅳ(10.8%),respectively.Eighty-seven patients received general anesthesia,eleven received neuraxial anesthesia,and two received peripheral nerve block.Supply-demand ratio was 88.6%for invasive arterial blood pressure monitoring and 107.1%for central vein catheterization.Conclusion Clinical anesthetists should sufficiently get familiar with the specific age and surgical types of risky patients,reasonably assess the cardiac function and accompanying diseases,rationally choose anesthetic techniques and agents,and actively establish invasive monitoring,to guarantee life safety for surgical patients.Undoubtedly,the improvement of anesthesia quality would greatly guarantee the safety of surgical patients in primary hospitals.