自制手术患者护理风险评估表的应用

目的探讨自制手术患者护理风险评估表的应用效果。方法设计手术患者护理风险评估表,内容包括病情、麻醉、手术和穿刺静脉4项,将4项结果经加权处理获得综合风险。对1 244例手术患者(应用后)进行风险评估,识别风险因素,根据风险级别实施分级管理,对风险因素采取规避措施。与评估表应用前的1 039例患者术中并发症和相关事件发生情况进行比较。结果评估表应用后,患者术中高血压、低血压、尿管脱出或堵塞、中心静脉导管脱出或堵塞发生率显著低于应用前(P0.05,P0.01)。结论手术患者护理风险评估表能够客观评估手术风险,可为手术患者风险防范提供参考。     

不同ASA分级老年患者术后心脏事件的观察

<正>老年患者因术前常合并隐匿性心脑肺等疾病,麻醉风险较大,故术前评估较为重要~([1])。目前临床上多采用ASA分级评估麻醉风险,但该分级标准受麻醉医师主观因素的影响较大,应结合一些客观便捷的指标进行麻醉前风险评估。本研究通过检测老年患者麻醉前后B型尿钠肽(B-type natriuretic peptide,BNP)和肌钙蛋白T浓度(cardiac troponin T,cTnT),探讨其与不同ASA分级患者术后心脏事件的一     

中国老年患者围术期麻醉管理指导意见

1老年患者术前访视与风险评估 1.1总体评估老年患者术前访视与评估是实施麻醉手术前至关重要的一环,其目的是客观评价老年患者对麻醉手术的耐受力及其风险,同时对患者的术前准备提出建议,包括是否需要进一步完善检查、调整用药方案、功能锻炼,甚至延迟手术麻醉,在条件允许的情况下尽可能地提高患者对麻醉、手术的耐受力,降低围术期并发症和死亡风险。老年患者术前应当根据美国麻醉医师协会（ASA）分级、代谢当量水平、营养状况、是否存在可疑困难气道、视力状况、精神从知状况、言语交流能力、肢体运动状况、是否急症手术、近期急性气道疾患、过敏史、脑卒中病史、心脏疾病病史、肺疾病病史、内分泌疾病病史、用药史（包括抗凝药物等）、头颈部放疗史、既往外科病史等对患者进行评估,以期全面掌握患者的身体状态。必要时,邀请相应多科专家参与讨论手术时机、方案以及相应的术前准备。     

画像式患者跌倒风险评估表的设计与应用

目的 提高住院患者跌倒风险评估效率和准确度。方法 分别以2021年2～12月和2022年1～11月的住院患者为对照组和研究组。对照组采用常规方法评估患者跌倒风险及实施相应防范措施;研究组依据患者跌倒风险因素制订画像式患者跌倒风险评估表进行评估及实施相应防范措施。随机选取对照组305例、研究组308例患者比较干预效果。结果 画像式患者跌倒风险评估表应用后住院患者跌倒发生率显著降低［RR=0.45,95%CI(0.36,0.65)］;研究组跌倒风险评估准确率、跌倒预防措施落实率及患者跌倒风险程度知晓率显著高于对照组（均P＜0.05）。结论 画像式患者跌倒风险评估表的应用有利于护士快速准确评估患者跌倒风险,有效防范跌倒,提高患者住院安全。     

国外静脉血栓栓塞症风险评估工具的研究进展

总结国外静脉血栓栓塞症风险评估分为团体风险和个人风险评估,前者是将患者从总体上进行风险分类,后者是通过风险评分方法来确定个人的风险。其中,个人风险评估根据包括Autar血栓风险评估量表、JFK医学中心血栓评估表、Caprini血栓评估表、Padua预测评分表、RAP评分法,分析各个量表的优劣,认为Padua预测评分表具有良好的信、效度,可作为国内护理人员用于评估患者静脉血栓栓塞症的评估工具;RAP评分法仍存在争议,需做进一步的临床验证。提出在借鉴国际上对VTE风险评估量表研究成果的基础上,根据我国人群的特点,研制适宜我国人群的VTE风险评估工具。     

基于Logistic回归分析的风险评估对医院感染的预防作用

目的探讨基于Logistic回归分析的风险评估对医院感染的预防作用。 方法回顾性分析本院2008年1月至2014年12月武汉科技大学附属孝感市中心医院1 626例住院患者的临床资料,根据患者住院期间是否发生医院感染分为感染组（520例）和对照组（1 106例）。通过Logistic回归分析确定医院感染危险因素并形成风险评估量表,对2015年1月至2016年2月收治的352例住院患者进行医院感染风险评估。 结果住院时间> 15 d、使用三联抗菌药物、使用呼吸机、留置导尿管、全身麻醉、合并肝病、合并血液性疾病、合并糖尿病、激素治疗、放疗或化疗、手术时间> 3 h以及侵入性操作均为医院感染的独立危险因素（P均< 0.05）。建立风险评估量表后医院感染发生率为25.00%,低于评估量表建立前的31.98%（χ² = 6.622,P < 0.05）。 结论基于Logistic回归分析的风险评估模型可有效评估患者感染风险,为医院感染的预防提供依据,并可有效降低医院感染风险。     

护士参与麻醉门诊术前教育对麻醉恢复期患者的影响

目的 探讨麻醉科护士参与麻醉门诊术前教育对全麻手术患者麻醉恢复期的影响。 方法 将2017年11～12月入麻醉门诊行麻醉评估的96例患者作为对照组,2018年5～6月入麻醉门诊行麻醉评估的96例患者作为观察组。对照组按照常规由麻醉医生进行麻醉风险评估和麻醉术前准备指导,观察组在对照组基础上,增设1名麻醉科护士配合麻醉医生,并开展麻醉术前教育。 结果 观察组气管插管耐受度、拔管配合度显著高于对照组,且患者的疼痛评估时间以及复苏时间显著短于对照组（P<0.05,P<0.01）。 结论 麻醉科护士参与麻醉门诊术前教育,有利于提高全麻手术患者麻醉恢复期对气管插管的耐受度及治疗配合度,同时可缩短患者疼痛评估所需时间及复苏时间。     

麻醉和手术风险数字化评估方法解读

术前对病人的评估是降低麻醉和手术并发症和死亡率的有效措施和常规。术前风险预测是根据病人生理状况、基础疾病、麻醉和手术对机体的影响,以数字量化评价风险水平的方法。麻醉医生根据病人风险水平,制定和反复修订麻醉和围术期医疗护理方案和采取防范措施,可以降低潜在风险,提高安全性和医护质量。除此之外,麻醉和手术风险预测还广泛地用于临床研究和质控等方面。常用麻醉和手术风险预测方法目前流行使用的风险预测方法达数十种之多。ASA是最简单最流行的方法,每个麻醉医生都会使用,但太粗糙,在复杂病情和手术等情况下有诸多限制。因此,…     

内科老年住院患者营养不良和营养风险评估分析

目的对内科老年住院患者营养不良及营养风险进行评估与分析。方法以我院内科2017年7月到2018年1月收治的212例老年患者为研究对象,于入院后第2 d测定前白蛋白(PA)、血清白蛋白(ALB)水平,并根据BMI、PA、ALB水平评估营养不良情况,同日完成NRS 2002营养风险评估。统计内科老年患者中营养不良和营养风险的检出率。结果 212例患者中,营养风险的发生率为38.2%;符合NRS 2002测定标准的患者共167例,营养风险的发生率为37.7%。以BMI18.5、PA200 mg/L以及ALB30 g/L营养不良判断依据,则营养不良检出率分别为9.0%、29.2%和2.7%。在BMI≥18.5的患者中,存在营养风险的占29.3%。农村患者的营养风险检出率高于城市患者,差异有统计学意义(P0.05)。结论不同的参考指标对评估内科老年住院患者营养不良检查率的结果影响较大,综合分析BMI、PA及ALB等指标进行分析或可得出更为客观的评价,NRS 2002评估结果提示农村患者的营养风险检出率高于城市患者。临床中应对来自农村的内科老年住院患者给予更为充分的营养评估与支持关注。     

老年人住院相关功能下降风险筛查及干预研究进展

阐述老年人住院相关功能下降的内涵及危险因素,总结住院老年人功能下降风险筛查工具,包括住院风险概况评估、老年人风险筛查评估、老年人风险筛查,住院患者评估、医院自理能力下降风险评估、复杂照护需求预测工具,干预主要包括个体层面的活动/运动单因素干预以及系统层面的多因素照顾模式。     

日间手术全周期闭环智慧系统管理实践与成效

目的 探讨日间手术全周期闭环智慧系统对日间手术的管理效果.方法 应用智慧系统实施日间手术全周期质量闭环管理,实现预约检查手术、手术精准确认、医护患全程手术信息共享,多维度宣教知识精准推送,按时逐级完成出院随访、过程质量控制等.结果 应用智慧系统管理后,患者术前检查完成率、病情评估完成率、麻醉访视完成率、首台准时麻醉率、...     

再谈围术期服用阿司匹林对手术和椎管内麻醉的影响

背景 对患有心血管疾病(cardiovascular disease,CVD)正在进行抗血小板治疗的患者,目前不仅无具体的、可被接受的围术期管理建议,而且对该类患者行椎管内麻醉存在争议,因接受抗血小板治疗可增加硬膜外血肿的风险. 目的 对阿司匹林的作用机制及其剂量、临床疗效与安全性关系进行综述. 内容 随着CVD患病率的不断增加,对接受阿司匹林治疗的高风险患者给予恰当的围手术期管理,是外科医师和麻醉医师共同面对的一个临床问题.为此,对需要行心血管或非心血管手术的CVD患者,必须在临床作出诸多治疗决策. 趋向 围术期抗凝治疗是以对血栓和出血事件的风险评估为依据的,应通过多学科协作来实现简化患者管理和最小化临床不良结局的治疗目标.     

Usefulness and problems of pre- and post-operative anesthesia evaluation clinic

A system of preoperative anesthesia evaluation clinic can provide a chance to evaluate the surgical patients effectively and to obtain an informed consent for anesthesia from the patients with their family. To organize this system effectively, communications with the doctors, nurses and comedical staffs in other departments/ sections are necessary. Postoperative anesthesia evaluation can be performed to gather information about patient satisfaction and postoperative anesthesia-related complications. This information can be used as a feedback to each anesthesiologist to improve anesthetic management. Establishment of anesthesia evaluation clinic can improve the safety and quality of anesthesia as well as efficiency of hospital management.     

Educating patients about anesthesia: a systematic review of randomized controlled trials of media-based interventions

In this systematic review, we compared the effectiveness of media-based patient education about anesthesia. Fifteen randomized controlled trials (n = 1506) were identified after a systematic search of electronic databases (MEDLINE, EMBASE, CINAHL, PSYCINFO, The Cochrane Controlled Trials Registry), published articles, and contact with authors. Outcomes assessed were anxiety, knowledge, and patient satisfaction. Anxiety levels before anesthesia were less intense in subjects receiving the video and printed information compared with those receiving no intervention (weighted mean difference of 3; 95% confidence interval [95%CI], 1-5 Spielberger's State and Trait Anxiety Inventory). Patients in the video group were more likely to answer all knowledge questions correctly compared with patients with no intervention (relative risk of 6.64; 95%CI, 2.05-21.52). The level of knowledge about pain management was higher in the video group compared with patients with no intervention (weighted mean difference of 17%; 95%CI, 9-25). However, the level of patient satisfaction with the intervention (expectation versus actual anesthetic experience) was similar between the groups (relative risk of 1.06; 95%CI, 0.93-1.22). This systematic review supports the use of video and printed information about general process and risks of anesthesia for patient education before surgery. IMPLICATIONS: The effectiveness of media-based interventions for educating patients about general process and risks of anesthesia were compared in this systematic review. The use of video and/or printed information can decrease patient anxiety and increase patient knowledge. However, patient satisfaction was similar between media-based intervention and nonintervention groups.     

Morphofunctional immaturity of the urinary tract and vesicoureteral reflux in young children

On the basis of rich clinical experience--593 patients and 916 renoureteral units (RUU) with vesicoureteral reflux (VUR) in infants the authors showed that early recognition of VUR is necessary, which is ensured by adequate organization of service to infants of the "risk group". Complex examination of children by functional diagnostic methods conducted under general anesthesia makes it possible to undertake some methods of examination for the detection and control of morphofunctional immaturity, while early application of purposeful rehabilitation measures in the stages inpatient treatment--outpatient treatment--treatment in the family produces a "positive dynamics" of the course of the pathological process in most patients (up to 82.1%). All this in complex confirms that morphofunctional immaturity of the urinary tract is the main cause of VUR in infants.     

Computer assisted patient evaluation (CAPE): a multi-purpose computer system for an anesthesia service

We have designed and built a database management system, the computer assisted patient evaluation (CAPE) system, for use in patient management, research, and administration in our anesthesia practice. An important part of the system is the use of specially designed forms on which anesthesiologists record patient histories and management information during the course of patient care. The forms provide means for convenient and complete record keeping, as well as for direct computerization. We demonstrate the flexibility and utility of the CAPE system by presenting a series of examples of its use. These include development and implementation of a preoperative screening program to identify patients at high risk of postoperative respiratory complications; a study of anesthesia technique and outcome; auditing for quality of care; and utilization review of respiratory therapy.     

老年患者术后认知功能障碍的危险因素

目的 筛选老年患者发生术后认知功能障碍(POCD)的危险因素.方法 择期手术患者240例,ASA Ⅰ或Ⅱ级,年龄65～86岁,根据麻醉方法不同分为3组(n=80):全身麻醉组(G组)、硬膜外阻滞组(E组)和局部麻醉组(L组).分别于术前1 d、术后1、3、5 d记录MMSE评分,计算术前MMSE评分的标准差,每例患者术后MMSE评分与术前MMSE评分比较≥1个标准差时即发生POCD.将不同年龄、性别、文化程度、麻醉方法、手术时间和术前MMSE评分的老年患者POCD发生率进行比较,若差异有统计学意义,该因素进入非条件logistic回归模型,筛选老年患者发生POCD的危险因素.结果 性别、文化程度、麻醉类型、手术时间≥90 min及术前MMSE评分＜23分不是老年患者POCD发生的危险因素;年龄≥75岁与老年患者POCD的发生有关(P＜0.05).结论 年龄≥75岁是老年患者发生POCD的危险因素.     

骨科老年患者呼吸道梗阻风险评估体系的构建及初步验证

目的 构建骨科老年患者呼吸道梗阻风险评估体系,早期识别高风险人群.方法 通过文献检索和小组讨论,拟定评估体系的初级指标,通过2轮专家咨询确定最终指标,并对指标进行初步验证.结果 构建的风险评估体系由年龄、意识状态、咳痰能力、痰液黏稠度、疼痛程度、可行体位、手术(受伤)部位、麻醉方式、基础疾病及高危因素10个指标构成.指...     

Risk evaluation and patient assessment in sedation

Risk assessment gives a good clinical guide to the understanding of our patients' medical problems. The dentist can cope with problems related to patients belonging to risks group 1 and 2, but not to groups 3 or 4. The results of studies on risks, morbidity, and mortality in anaesthesia teach us that the human factor and technical error provoke complications, morbidity and mortality, seemingly unnecessarily. Case history and a simple physical examination, primarily concentrated on respiration and circulation, are of greatest importance. Main risks during conscious sedation are regurgitation and aspiration of fluid and smaller objects, such as a broken dentist's drill or a cardiac complication. Most feared is the risk of of a reinfarcation. The aim of sedation is to reduce anxiety and restlessness. Of greatest importance is thorough patient information and a good doctor–patient contact.     

Factors influencing patient disposition after ambulatory herniorrhaphy

Purpose:

To determine factors associated with patient disposition status other than discharge to their customary residence (DCR) after elective, ambulatory inguinal hernia repair (IHR).

Materials and methods:

N = 7953 patients who underwent IHR were identified in the National Survey of Ambulatory Surgery (NSAS). Disposition status was examined by age, sex, race, type of anesthetic, anesthesia provider, expected source of payment, laterality of the procedure, facility type and US region. Logistic regression was used to examine independent risk factors for such disposition status.

Results:

Independent risk factors for disposition status other than DCR included anesthesia type, anesthesia provider, increasing age of the patient, and bi- versus unilaterality of the procedure. Differences in disposition status were also found by facility type and US region in which the procedure was performed.

Discussion:

The increased cost associated with a disposition status other than DCR requires identification of factors that independently contribute to such an outcome. In this study a number of anesthesia related and unrelated factors were identified that may impact on the disposition of patients undergoing ambulatory inguinal hernia repair. In light of limitations inherent to analysis of large databases our results should be interpreted with caution and prospective trials are needed for validation of our findings. The value of our results may lie particularly in the hypothesis generation for such trials.