基于时间-动作法的精益管理模式在非体外循环冠脉旁路移植术患者术中的应用

Effect of lean management based on time-action in patients undergoing off-pump coronary artery bypass grafting

目的探讨基于时间-动作法的精益管理模式在非体外循环冠脉旁路移植术(OPCABG)患者手术室护理管理中的应用效果。方法采用便利抽样法,选取临汾市中心医院心脏大血管外科2019年1月—2020年12月收治的248例OPCABG手术患者为研究对象,将2019年1—12月收治的患者设为对照组(n=120),2020年1—12月收治的患者设为观察组(n=128),对照组行常规手术室护理管理,观察组在对照组基础上行基于时间-动作法的精益管理。比较两组患者手术室护理质量、手术相关指标、护理风险事件、中转体外循环及术后早期并发症发生情况。结果观察组设备仪器管理得分为(27.65±1.73)分、护理人员配合得分为(27.41±1.88)分、物品器械准备得分为(18.37±1.29)分及护理质量总分为(92.08±3.92)分,比对照组的(24.48±1.89)、(25.35±1.64)、(16.45±1.82)、(84.86±4.79)分高,差异均有统计学意义(P<0.01)。观察组术前准备时间为(27.08±6.64)min、手术时间为(174.12±42.55)min、接送时间为(21.68±5.35)min,较对照组的(35.62±7.81)、(192.55±43.06)、(26.44±6.57)min短,差异均有统计学意义(P<0.01)。观察组术中最低鼻咽温为(34.79±0.84)℃、最低红细胞比容为(33.66±2.74)%,较对照组高,差异均有统计学意义(P<0.01)。观察组护理风险事件总发生率2.34%(3/128)、中转体外循环率为1.56%(2/128)、术后并发症总发生率为18.75%(24/128),低于对照组的8.33%(10/120)、6.67%(8/120)、31.67%(38/120),差异均有统计学意义(P<0.05)。结论在OPCABG患者手术室护理管理中应用基于时间-动作法的精益管理模式,可提高护理质量,改善手术效率及安全性,有利于降低中转体外循环、护理风险事件及术后并发症发生率。

Objective To explore the effect of the lean management based on time-action in the nursing management of patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods From January 2019 to December 2020,convenience sampling was used to select 248 patients undergoing OPCABG who were admitted to the Cardiovascular Surgery of Linfen Central Hospital as the research object.The patients admitted from January to December 2019 were set as the control group(n=120),and the patients admitted from January to December 2020 were set as the observation group(n=128).The control group was given routine Operating Room nursing management,while the observation group was given time-action based lean management on the basis of the control group.The Operating Room nursing quality,operation-associated indicators,nursing risk events,transfer to cardiopulmonary bypass and early postoperative complications were compared between the two groups.Results In the observation group,the score of equipment and instrument management was(27.65±1.73),the score of nurse cooperation was(27.41±1.88),the score of equipment preparation was(18.37±1.29),and the total score of nursing quality was(92.08±3.92),and the scores were higher than those of the control group[(24.48±1.89),(25.35±1.64),(16.45±1.82),and(84.86±4.79)],with statistical differences(P<0.01).In the observation group,the preoperative preparation time was(27.08±6.64)min,the operation time was(174.12±42.55)min,and the pick-up time was(21.68±5.35)min,which were shorter than those of the control group[(35.62±7.81)min and(192.55±43.06)min,(26.44±6.57)min],and the differences were statistically significant(P<0.01).The lowest intraoperative nasopharyngeal temperature in the observation group was(34.79±0.84)℃,and the lowest hematocrit was(33.66±2.74)%,which were higher than those in the control group,and the differences were statistically significant(P<0.01).In the observation group,the total incidence of nursing risk events was 2.34%(3/128),the rate of transfer to cardiopulmonary bypass was 1.56%(2/128),and the total incidence of postoperative complications was 18.75%(24/128),which were lower than those of the control group[8.33%(10/120),6.67%(8/120),31.67%(38/120)],and the differences were statistically significant(P<0.05).Conclusions The application of the lean management based on time-action in the nursing management of OPCABG patients in the Operating Room can improve the quality of nursing,efficiency and safety of surgery,and help reduce the incidence of cardiopulmonary bypass,nursing risk events and postoperative complications.