系统提高中国麻醉安全之策略

Systemic strategies to improve anesthesia safety in China

由于麻醉工作者的不懈努力,麻醉安全在过去一个世纪已有长足进步。在中国,麻醉安全还有很大提升的空间。系统提高中国麻醉安全之策略包括不同的层面。在国家层面,卫生部委应与中华医学会麻醉学分会及其他麻醉协会一起努力推广和改进住院医师规范化培训及标准的全国统一的考核;建立行业标准及相关条例;建立健全全国和各地区麻醉数据资料库,并建立全国麻醉质量监测中心;设置全国通行手术室最低装备,监护和人员配置的最低标准;在全国范围内大规模推广实施WHO建议的安全手术核查单,在麻醉前,术前和术后进行有外科医生、麻醉医生、手术室护士的三方核对。在医院层面上,医院管理层应该给麻醉科及手术室配备足够的设备仪器,并配置有足够训练的围术期从业人员;麻醉科及医院在平时都要有紧急预案,包括应急机制和应急人员,麻醉科室需要定期培训麻醉医生的危机处理能力,并为医院其他科室提供气道管理方面的培训;医院领导层必须认识到麻醉学科既是医院的平台学科也是医院的枢纽科室,加强麻醉学科的建设对于医院的发展是非常重要的;各级医院应该建立并完善隐患及事故的上报和登记系统,认识到这是改进围术期患者安全的重要手段。麻醉医生个人也应该坚持不懈地提高自己的职业技能和素养,在术前必须认真评估手术患者的病理生理状态,术前与患者及家属进行详尽客观的交流,让患者理解手术和麻醉可能带来的副反应。并且,麻醉医生在手术前应该有充分的麻醉准备,这是实施安全,高质量麻醉之关键;在手术过程中麻醉医生及围手术期工作人员应该维持高度的警觉性,这是保证患者安全的至关重要的因素。只有通过多个层面的系统努力,麻醉安全才可能有整体的提高。

Anesthesia safety has been improved dramatically over the last century as a result of the tremendous efforts by anesthesia community worldwide. Strategies at different levels can be adopted in China to further improve anesthesia safety for Chinese patients. On the national level, Chinese Ministry of Health can work with Chinese Society of Anesthesiology （CSA） to improve standardized anesthesia residency training and anesthesiology certification examination, establish Standard of Care, start national and regional anesthesia data registry, set up a minimum equipment requirement for surgical operating room, minimum staffing requirement and minimum training requirement for perioperative personnel, and promote nationwide utilization of WHO Safe Surgery Checklist. On the hospital level, hospital administration should provide perioperative services with adequate equipment, adequate staffing and adequate training of employees. Hospital should have Emergency Preparedness protocol and Department of Anesthesiology should provide regular training in Crisis Manage- ment. Hospital and Department of Anesthesiology should also encourage reporting of incident and mishaps, and have regular Morbidity and Mortality discussions. All anesthesia providers should thoroughly review pertinent patient information preoperatively, have backup plans for all potential problems, maintain highly vigilant intraoperatively, and closely monitor recovering patient postoperatively. By adopting these strategies and working closely between all levels of anesthesia providers, we can surely improve our anesthesia safety for our patients.