江苏省老年人群消化内镜麻醉问卷调查及分析

Questionnaire survey and analysis of anesthesia for gastrointestinal endoscopy in the elderly in Jiangsu Province

目的调查与分析江苏省老年人群消化内镜麻醉状况,以助力提升江苏省老年人群消化内镜麻醉质量。方法设计老年人群消化内镜麻醉规范调查表,于2022年2月13~28日在江苏省麻醉医师微信群发放电子调查问卷。调查问卷分为19个问题,包括个人资料、医院资料、麻醉日常诊疗行为与医疗安全等。结果共回收问卷520份,纳入有效问卷501份,有效率为96.3%,其中三级医院、副主任医师及以上麻醉医生占比分别为69.2%、60.5%。问卷结果显示,52.1%的麻醉医生设置老年人群消化内镜麻醉年龄上限;常规监测老年人群心电、无创血压的麻醉医生分别占64.3%、84.0%;无创血压袖带置于老年病人左上肢的麻醉医生占35.5%;氧气湿化处理、进行液体输注以及眼睛保护的麻醉医生分别占61.5%、55.1%与23.6%;18.4%的麻醉医生不常规处理老年人群低血压;医院设麻醉恢复区、设专人负责麻醉恢复区、常规急救培训以及设置离室标准的麻醉医生比例分别为82.4%、68.5%、61.7%与90.0%;无医务人员陪同老年病人回到病房比例高达80.4%。三级医院不设置老年人群麻醉年龄上限、开设老年人群麻醉评估门诊、设置麻醉恢复室、安排专人负责麻醉恢复室以及实施离室前安全评估的比例较高(P<0.05),实施老年人群氧气湿化处理与液体输注的比例较低(P<0.01)。另外,住院医师实施眼睛保护比例最高(P=0.024)。结论江苏省范围内老年人群的消化内镜麻醉管理目前仍存在较多问题,亟需加强相关麻醉标准化流程培训和质量管理,以有效保障老年人群麻醉安全。

Objective To investigate and analyze the situation of anesthesia for gastrointestinal endoscopy in the elderly in Jiangsu Province,so as to improve the quality of anesthesia for gastrointestinal endoscopic procedures in this population.Methods The anestheia specification for gastrointestinal endoscopy in the elderly questionnaire was designed,and was conducted among anesthesiologists working in Jiangsu Province via the WeChat group application between February 13-28,2022.The questionnaire was divided into 19 parts,including personal information,hospital information,routine practice of anesthesia and medical safety for the elderly.Results A total of 520 questionnaires were completed,of which 501 were valid with an effective rate of 96.3%.The questionnaire showed that 69.3%of the respondents were from tertiary hospitals and 60.5%of anesthesiologists were chief physicians or senior.52.1%of the participants listed an upper age limit for elderly patients and 59.7%conducted preoperative evaluation of anesthesia for gastrointestinal endoscopy.64.3%of the participants chose electrocardiograph(ECG)monitoring and 84.0%chose non-invasive blood pressure monitoring.Blood pressure was measured by noninvasive blood pressure cuff and were cuffed on left upper limb(35.5%).The ratio of humidification during oxygen therapy,liquid infusion intravenously,eye protection was 61.5%,55.1%and 23.6%,respectively.The current status such as no treatment for hypotension during endoscopy(18.4%),providing area for recovery from anesthesia(82.4%),professional staffs for recovery(68.5%),regular first-aid training(61.7%),discharge eligible standardization(90.0%),accompanied without medical staffs when returning to the ward(80.4%)were also recorded.There were higher ratios of tertiary hospitals in no upper age limit for the elderly,conducting preoperative evaluation of elderly anesthesia as well as setting post-anesthesia recovery room,professional staffs,and discharge eligible standardization(P<0.05).However,the ratios of tertiary hospitals in humidification during oxygen therapy and intravenous liquid infusion were lower(P<0.01).Interestingly,residents mostly chosed eye protection(P=0.024).Conclusions There are still many problems in the anesthesia management of gastrointestinal endoscopy in the elderly in Jiangsu Province.It is necessary to improve the standardization and quality management in routine practice of anesthesia,in order to effectively guarantee the safety of anesthesia for the elderly.