甲状腺癌手术患者标准化风险预警指标体系的建立及应用分析

目的构建甲状腺癌手术患者标准化风险预警指标体系,落实甲状腺癌术后的风险管理.方法基于文献检索,结合临床经验总结,通过德尔菲法设计甲状腺术后风险评估量表、制作改良式颈胸加压带、制定甲状腺术后出血应急流程,修订和完成甲状腺癌手术患者标准化风险预警指标体系方案,纳入289例甲状腺癌术后患者进行风险预警体系评估.结果289例甲状腺癌手术患者通过标准化风险预警指标体系管理,发现潜在严重风险共39例,其中出血风险9例,8例出血经颈胸加压带加压12~24 h后症状缓解,1例出血风险经干预措施无效按甲状腺术后应急流程再次手术.结论甲状腺术后标准化风险预警指标体系的建立,明显提升临床护士对甲状腺术后早期病情变化的预见能力,达到并发症早期干预的目的,降低患者二次手术率.

Objective To establish a standardized risk early warning system for thyroid cancer patients,and implement to risk management after thyroid cancer surgery.Methods Based on literature search and 2015 thyroid cancer NCCN guidelines for the severity of thyroid postoperative complications,combined with clinical experience conclusion.Delphi method were made to set the thyroid surgery risk assessment scale,neck and chest compression bands design and the postoperative bleeding emergency procedure,revised and completed the standardized risk early warning system for thyroid cancer surgery patients.Results A total of 289 parients with thyroid cancer surgery were included by a standardized risk warning indicator system.A total of 39 potential risks items were identified,including 9 cases of bleeding risk,and 8 cases of bleeding were relieved after 12 to 24 hours compression through neck/chest compression belt.Intervention was invalid in one case,and the operation was repeated according to the emergency procedure of thyroid surgery.Conclusion The establishment of a standardized early warning index system for thyroid surgery can significantly improve the predictive ability of clinical nurses,reach the early intervention of complications,reduce secondary surgeryrate,and deal with complications immediately.