加强围手术期危机事件管理 提升儿科麻醉安全和质量  

Enhance the management of perioperative crisis events,improve the safety and quality of pediatric anesthesia

作　　者：韩园[1] 李军[1] Han Yuan;Li Jun(Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University,Wenzhou 325024,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院麻醉与围术期医学科,温州325024

出　　处：《中华医学杂志》2024年第23期2097-2101,共5页National Medical Journal of China

基　　金：重大新药创制国家科技重大专项(2020ZX09201002)

摘　　要：围手术期危机事件是指在手术期间或手术后发生的、非预料之中的患者生命受到严重威胁的状态,需要临床团队快速识别、评估和管理,最大限度减少对患者的伤害。而围手术期儿科麻醉的管理对于麻醉医师尤其具有特殊性和挑战性,需要麻醉医师具备专业的技术和非技术技能。本文主要阐述围手术期儿科麻醉危机事件的发生率和风险因素,引入麻醉危机资源管理的概念以及处理策略。并以恶性高热典型危机事件为例,介绍了麻醉团队需采取的麻醉危机资源管理策略,包括及时识别危机征兆、迅速终止诱发药物、静注特效药丹曲林钠、物理降温及对症支持治疗、积极寻求其他团队协助、记录和反馈等。以期提高麻醉医师的认知决策能力和团队合作能力,从而有效预防和应对可能发生的潜在危机事件,保障患儿围手术期的安全。Perioperative crisis events refer to unexpected seriously life-threatening when the patient is during or after surgery,and require rapid identification,evaluation,and management by clinical teams to minimize harm.The pediatric anesthesia management during perioperative period is special and challenging for anesthesiologists,requiring professional technical and non-technical skills.The article mainly elaborates on the incidence and risk factors of pediatric anesthesia crisis events during perioperative period and introduces the concept of anesthesia crisis resource management and strategies.The anesthesiologist team needs to adopt a crisis resource management strategy,taking a typical crisis event of malignant hyperthermia as an example,including identification of crisis signs immediately,termination of trigger drugs rapidly,intravenous injection of the special drug dantrolene,physical cooling,and symptomatic support treatment,seeking assistance from other teams actively,recording and feeding back.This study aims to improve the cognitive decision-making ability and teamwork ability of anesthesiologists and their teams,effectively preventing and responding to potential crisis events effectively,and ensuring the safety of pediatric patients during perioperative period.

关 键 词：麻醉 儿童 危机事件 危机资源管理 恶性高热 

分 类 号：R726.1[医药卫生—儿科]