心脏外科手术关胸操作的质量监督  

QUALITY CONTROL OF CARDIAC OPERATIONS

作　　者：江飞舟[1] 丁以群[1] 

机构地区：[1]广东省人民医院,广东广州510080

出　　处：《现代医院》2007年第6期127-128,共2页Modern Hospitals

摘　　要：目的探讨心脏外科领域质量监督的方法。方法某一医生一年中共进行233例体外循环手术关胸操作,第112例、第215例、第219例、第230例、第231例患者因术后出血量过多而需要进行再开胸止血;采用累计求和法(CUSUM)进行统计,设定目标失败率为2%,警告失败率为5%。结果在本阶段中,A医生手术再开胸止血发生率尚低于2%。结论①相对集中出现的手术失败原因包括:偶然因素、人为因素和某一时间段内所呈现的频发高危因素等等;②手术失败的原因可以划分为技术层面、管理层面和人为层面;而失败也可以划分为显性失败和隐性失败;③心脏外科领域的质量控制有三个基本步骤,即洞察问题的存在、发现导致问题的可能因素和修正错误。Objective To explore a method to control the quality of cardiac operations. Methods Dr. A performed 233 cases of chest closure after CPB operations during one year, cases 112, 215, 219, 230 and 231 received reexploration for mediastinal bleeding. Cumulative sum procedure was used to do the statistic, setting the target reexploration rate as 2% and the alternative reexploration rate as 5%. Results Dr. A＇ s reexploration rate for mediasfinal bleeding was still less than the target rate 2% during this period. Conclusions ① The causes of a cluster operation failure include causal factors, human factors and some high - risk factors. ②The causes of failures could be classified as technical level, organizational level and human level. Failures include active failures and latent failures. ③There are three steps to control the quality of cardiac operations ： detecting the latent problems, seeking the potential risk factors and improving the quality.

关 键 词：心脏外科 质量监督 累计求和法 

分 类 号：R654.2[医药卫生—外科学]