手术及麻醉不良事件与手术安全核对制度执行情况的评估

发布时间：2018-05-03 03:03

本文选题：手术及麻醉不良事件 + 手术安全核对表　；参考：《北京协和医学院》2012年博士论文

【摘要】：背景：为了改善手术患者安全,有必要对手术及麻醉不良事件与手术安全核对制度的现状进行全面评估。目的：明确我院手术及麻醉不良事件的现状,寻找高效客观的不良事件评估方法并预估手术的不良事件风险水平,评价目前手术安全核对制度的执行情况。方法：通过统一格式的病历回顾表及问卷调查表,对2012年2月及3月在我院基本外科、胸外科及肝脏外科住院行择期手术的464例患者的不良事件发生情况及手术安全核对制度的执行情况进行全面评估。结果：通过病历回顾研究,共发现发生于98名患者(21.1%)的手术及麻醉不良事件132件(28.4件／百例手术),其中以感染发生率为最高。通过问卷调查研究得到的不良事件发生情况与病历回顾研究所得结果存在显著性差异。全美医院感染监测(NISS)手术风险分级系统可以有效地预估不良事件风险水平。手术安全核对的执行情况显示仅27.0%手术团队完成了所有的核对项目,而仅47.3%的手术团队进行了离室前核对。结论：本研究所发现的手术及麻醉不良事件发生率与国外文献所报道水平相比偏高。提示传统的不良事件病历回顾方法还需进一步完善,但并发症问卷调查仍难以替代病历回顾对不良事件进行监控。手术安全核对制度在执行过程中尚存在诸多不规范情况。
[Abstract]:Background: in order to improve the safety of surgical patients, it is necessary to evaluate the current situation of safety check system of surgery, adverse events of anesthesia and operation. Objective: to identify the present situation of surgical and anaesthesia adverse events in our hospital, to find out an effective and objective evaluation method of adverse events, to estimate the risk level of adverse events, and to evaluate the implementation of the current safety check system. Methods: the basic surgery in our hospital in February and March 2012 was studied by using a unified medical record retrospective form and a questionnaire. The incidence of adverse events and the implementation of the safety check system were comprehensively evaluated in 464 patients with elective surgery in thoracic and liver surgery. Results: according to the retrospective study of medical records, we found that 132 adverse events of anesthesia and operation occurred in 98 patients (28.4 / 100 cases), among which the incidence of infection was the highest. There was significant difference between the adverse events and the results of retrospective study. The National Nosocomial infection Surveillance (NISS) surgical risk classification system can effectively predict the level of adverse event risk. The results of safety check showed that only 27.0% of the operation team had completed all the check items, while only 47.3% of the operation team had performed pre-room check. Conclusion: the incidence of adverse events of operation and anesthesia in this study is higher than that reported in foreign literature. It suggests that the traditional review method of adverse event medical records needs to be further improved, but the complication questionnaire is still difficult to replace the review of medical records to monitor the adverse events. There are still many irregularities in the operation safety check system.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R612

【共引文献】