麻醉风险与质量评估学的创立和研究  

Establishment and study on anesthesia risk and quality evaluation system

作　　者：肖生红[1] 刘先保[1] 詹鸿[1] 

机构地区：[1]广州医学院第三附属医院,广州市510150

出　　处：《国际医药卫生导报》2013年第16期2572-2575,共4页International Medicine and Health Guidance News

摘　　要：目的建立一整套完善具体的麻醉风险与质量评估学理论体系，从回避麻醉风险及事故的角度分析总结经验教训以提高麻醉质量减少并发症及事故的发生并为麻醉学建立一门能客观预估麻醉风险和提高麻醉质量的二级学科。方法收集本医院近二十年各种不同类型麻醉病例，尤其对急、危、重、罕见、抢救病例进行评估、反思、总结其麻醉质量、麻醉经验和风险；收集本省市及本医院近二十年各种不同类型麻醉事故／并发症／麻醉赔偿官司并进行评估、反思、总结其经验教训。结果106例麻醉导致脑死亡（植物人）其主要原因是手术中低血压、低血氧或心跳骤停时间过长、抢救不及时或麻醉复苏清醒评分不足导致，75例麻醉截瘫和马尾综合征其主要原因是病人过胖过矮致摸不清椎体间隙且穿刺粗暴或穿刺点过高，也有3例因用药错误或不慎导致麻醉死亡病例，有4例因术前谈话不充分导致赔偿个案，有56例因术中大出血抢救无效死亡及困难插管导致死亡。结论发现容易出事故和风险的情形很容易再次出现，即重复相同原因出现相同的差错和事故．有必要建立一整套麻醉风险与质量评估的理论指导体系，有必要为麻醉学建立一门能客观预估麻醉风险和提高麻醉质量远离麻醉事故的二级学科一麻醉风险与质量评估学。Objective To establish a detailed anesthesia risk and quality evaluation system for the decrease of the incidence of anesthesia accident and to establish a second-class subject of predicting anesthesia risk and anesthesia quality. Methods We collected the anesthesia cases of The Third Affiliated Hospital of Guangzhou Medical College in recent 20 years, analyzed and summarized the anesthesia risk, quality and experience for the anesthesia cases in particular the emergent, critical, severe, seldom-seen, and rescued ones. The anesthesia accidents and anesthesia complications in our hospital as well as the anesthesia lawsuit concerning claiming for compensation in Guangdong province were also analyzed. Results 106 anesthesia-induced brain death （vegetative state） cases were mainly caused by hypotension and low blood oxygen, failure in rescue for long-time cardiac arrest or inadequate anesthesia resuscitation-consciousness, 75 anesthesia-induced paraplegia and cauda equina syndrome cases were mainly caused by mistaken location of intra-vertebral space in the fatter or shorter cases or violent puncturation, 3 cases were dead for the mistaken medication, 4 cases claimed for compensation for improper preoperative conversation, and 56 death cases were induced by operative hemorrhea and having difficulties in intubation. Conclusion Anesthesia accident and risk usually recur under the same situation, and so it is necessary to establish a detailed anesthesia risk and quality evaluation system and the second-class subject of predicting anesthesia risk and anesthesia quality for avoiding anesthesia accident.

关 键 词：麻醉风险 麻醉质量 评估 

分 类 号：R614[医药卫生—麻醉学]