医疗失效模式与效应分析干预对患者术中心身状态的影响

The influence of health care failure mode and effect analysis on intraoperative psychosomatic state of patients undergoing surgery

目的探讨医疗失效模式与效应分析干预对外科手术患者术中心身状态的影响。方法将256例外科手术患者依据患者意愿分为研究组和对照组,各128例。对照组患者给予常规临床干预,研究组患者给予医疗失效模式与效应分析干预,观察住院全程。比较两组患者的自主神经症状情况,比较干预前后两组患者的心率、呼吸频率、心境状态量表(POMS)评分、恐惧症自评量表(SPS)评分和超敏C反应蛋白、血清皮质醇水平。结果干预后研究组患者狂躁、濒死感、大汗淋漓、呼吸困难、颤抖心悸的发生率低于对照组(P<0.05)。干预后研究组患者心率和呼吸频率升高程度均小于对照组(P<0.05或0.01)。干预后两组患者POMS的总分及紧张、愤怒、疲劳、压抑、慌乱项目评分,SPS评分,超敏C反应蛋白、血清皮质醇水平较干预前降低,且研究组低于对照组;两组患者POMS的精力充沛、有自尊感项目评分均较干预前升高,且研究组患者有自尊感项目评分高于对照组(P<0.05或0.01)。结论医疗失效模式与效应分析干预能够缓解外科手术患者的自主神经症状,稳定心率和呼吸频率,改善恐惧状况,进而改善术中幽闭情况。

Objective To explore the influence of healthcare failure mode and effect analysis(HFMEA)on intraoperative psychosomatic state of patients undergoing surgery.Methods A total of 256 surgical patients were divided into research and control group based on their willingness,with 128 ones in each group.Control group received routine clinical intervention,research group did the HFMEA,and the whole courses of hospitalization were observed.Autonomic symptoms as well as such indexes were compared between two groups as pre-and post-intervention heart rates(HR),respiratory rates(RR),the Profile of Mood State(POMS)Questionnaire and Self-rating Phobia Scale(SPS)scores,and hypersensitive C-reactive protein(hs-CRP)and cortisol levels.Results The incidences of mania,feeling of impending death,profuse sweating,difficult breathing,jitters and palpitations were lower in research than control group(P<0.05);after intervention HRs and RRs in both groups elevated compared with pre-intervention and those were lower in research than control group(P<0.05 or 0.01);after intervention the total score of POMS,and score of tension,anger,fatigue,depression,and confusion as well as the SPS scores,and hy-CRP and cortisol levels in both groups lowered compared with pre-intervention and those were lower in research than control group(P<0.05);after intervention vigor and self-esteem scores of the POMS in both groups elevated compared with preintervention and the self-esteem was higher in research than control group(P<0.05 or 0.01).Conclusion The HFMEA could alleviate autonomic symptoms,stabilize heart and respiratory rates,and improve phobia status and then intraoperative claustrophobia in surgical patients.