连续股神经阻滞的安全隐患分析及护理

Safety Analysis and Nursing Experience of Continuous Femoral Nerve Blocks

目的：通过对全膝关节置换（total knee arthroplasty，TKA）术后使用连续股神经阻滞（continuous femoral nerve block，CFNB）镇痛泵的患者进行针对性护理干预，减少使用连续股神经阻滞镇痛的安全隐患。方法2010年1月～2014年12月共行2852例 TKA，术后均使用 CFNB 镇痛泵，2012年12月前1483例采用常规护理，2013年1月后1369例加强安全管理，采用针对性护理，回顾病例资料，统计不良事件如患者跌倒的发生情况。结果2012年12月前1483例发生不良事件6例（0．4％），均为跌倒，2013年1月后1369例未发生不良事件，二者差异有显著性（Fisher 检验，P ＝0．032）。结论完善预防跌倒流程，术后早期采取干预措施，可以有效减少连续股神经阻滞镇痛的跌倒安全隐患的发生。

Objective To reduce safety risks of patients who use continuous femoral nerve block （CFNB）after total knee arthroplasty （TKA）by applying intensive nursing care. Methods There were 2852 cases of TKA receiving CFNB after operation performed in this ward from January 2010 to December 2014.Among them,1483 cases before December 2012 were followed by normal nursing care,while 1369 cases after January 2013 were followed by intensive nursing care.By reviewing case data,the number of occurrences of adverse events,such as falls,was counted. Results There were 6 cases （0.4%）of adverse events occurred after operation,all of which were falls,before December 2012,while no adverse events from January 2013 to December 2014 was observed. The difference between the two groups was significant （Fisher’s Exact Test,P =0.032 ）. Conclusion Improvement of fall prevention protocol and early intervention after operation can effectively reduce the incidence of falls.