麻醉恢复室24例严重低氧血症的回顾性分析

A retrospective analysis of 24 cases of severe hypoxemia in the post anesthesia care unit

目的分析麻醉恢复室(PACU)严重低氧血症的发生原因,以期为保证患者麻醉恢复期生命安全,提高工作质量提供临床指导。方法利用Docare手术麻醉系统,回顾2015-01-01/2017-12-31期间收住我院PACU发生严重低氧血症的患者,通过质量与安全管理小组成员实施头脑风暴、进行根因分析、查找原因并拟定对策。结果PACU收住患者中发生严重低氧血症共24例,占PACU患者总数的0.07%,占全身麻醉患者的0.09%。术前合并呼吸系统疾病、阿片类药物的不规范使用、肌松药残留是导致PACU严重低氧血症发生的主要原因。结论针对诱发因素,通过麻醉门诊优化术前访视、规范镇痛药物使用、联合多模式镇痛、加强术中监测、细化转运流程等干预措施持续质量改进,以期降低严重低氧血症的发生率,保证患者围术期安全,提高患者恢复质量,加速患者康复。

Objective To analyze the causes of severe hypoxemia in the post anesthesia care unit(PACU),ensure the safety of patients and improve the quality of patients’recovery from anesthesia.Methods All patients with severe hypoxemia in PACU of Liaocheng People s Hospital were reviewed by Docare surgical anesthesia system from January 1,2015 to December 31,2017.Quality and safety management team members conducted brainstorming and root cause analysis to find the causes and drew up countermeasures.Results A total of 24 cases of severe hypoxemia in PACU occurred,accounting for 0.07%of the total admitted patients in PACU and 0.09%of the total admitted patients under general anesthesia.Preoperative respiratory diseases,irregular use of opioids and muscle relaxant residues were the main causes of severe hypoxemia in PACU.Conclusion According to the inducing factors,the intervention measures such as optimizing the preoperative visit,normalizing the use of analgesics,combining multi-mode analgesia,strengthening intraoperative monitoring,and refining the transfer process should be taken to continuously improve the safety of patients,so as to reduce the incidence of severe hypoxemia in PACU,ensure the safety of patients during the perioperative period,improve the quality of patients recovery,and enhance their recovery.