肺癌根治术体位安置管理中引入失效模式与效应分析的效果

Effect of introducing failure mode and effect analysis in postural placement management for radical resection of lung cancer

目的:探讨肺癌根治术体位安置管理中引入失效模式与效应分析(failure mode and effects analysis,FMEA)的效果。方法:选择2019年3月至2021年3月无锡市锡山人民医院收治的行肺癌根治术的患者120例,随机分为对照组与观察组。对照组行常规体位安置管理,观察组在体位安置管理中引入FME A干预,并制订改善措施。对比两组体位安置前后血压、气道压、心率变化及手术时间、手术体位相关并发症发生率、凝血指标及术后舒适度情况。结果:观察组安置后舒张压、收缩压、气道压、心率均低于对照组(均P<0.05);观察组手术时间短于对照组(P<0.05);观察组手术体位相关并发症发生率低于对照组(P<0.05);观察组手术结束后1 h的活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)高于对照组,纤维蛋白原(fibrinogen,Fbg)低于对照组(P<0.05);观察组术后舒适度优于对照组(P<0.05)。结论:肺癌根治术体位安置管理中引入FMEA可缩短手术时间,识别并消除患者潜在的风险,维持术中循环功能,降低手术体位相关并发症发生率,改善凝血指标,提高术后舒适度。

Objective:To explore the effects of introducing failure mode and effects analysis(FMEA)in the management of postural placement during radical resection for lung cancer.Methods:A total of 120 patients undergoing radical lung cancer surgery in our hospital from March 2019 to March 2021 were selected and randomly divided into two groups.The control group received routine postural placement management,and the observation group introduced FMEA intervention in the management of body position placement and formulated improvement measures.The changes of blood pressure,airway pressure,heart rate and operation time,the incidence of complications related to the operation position,coagulation indexes and postoperative comfort were compared between the two groups before and after placement.Results:After placement,the diastolic blood pressure,systolic blood pressure,airway pressure,and heart rate of observation group were lower than those of the control group(P<0.05);the observation group had shorter operation time than the control group(P<0.05);the incidence of complications related to the surgical position of the observation group was lower than that of the control group(P<0.05);the activated partial thromboplastin time(APTT),prothrombin time(PT)and thrombin time(TT)of the observation group were higher than those of the control group at 1 h after the operation,and the fibrinogen(Fbg)was lower than that of the control group(P<0.05);postoperative comfort of the observation group was better than that of the control group(P<0.05).Conclusion:The introduction of FMEA in the management of postural placement in radical lung cancer surgery can shorten the operation time,identify and eliminate potential risks of patients,maintain intraoperative circulatory function,reduce the incidence of complications related to surgical position,improve blood coagulation indicators,and improve postoperative comfort.