手术安全核查对直肠癌术后临床结局影响的研究  

Impact of the surgical safety checklist on postoperative clinical outcomes in rectal cancer patients

作　　者：王浩 周岩冰[2] 张佃良[2] 牛兆建[2] 王东升[2] 陈栋[2] 吕亮[2] 李宇[2] 曹守根[2] 

机构地区：[1]山东省东营市人民医院胃肠外科 [2]青岛大学附属医院普外科,山东省266003

出　　处：《中华普通外科杂志》2015年第5期369-373,共5页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（81270449）;山东省自然科学基金资助项目（ZB2012HM046）;青岛市民生科技计划项目（14-2-3-5-nsh）

摘　　要：目的 探讨手术安全核查对直肠癌患者术后临床结局的影响.方法 收集青岛大学附属医院2007年4月至2013年3月手术的2 157例直肠癌患者的临床资料,按手术安全核查的实施时间将资料分为核查前组（2007年4月至2010年3月）和核查后组（2010年4月至2013年3月）,应用x2检验、独立样本t检验及非参数检验对两组患者的临床资料进行比较,用多因素Logistic回归分析手术安全核查与术后并发症的关系.结果 核查后组术后并发症的发生率为15.98％（195/1 220）,明显低于核查前组的20.38％ （191/937）（x2=6.985,P=0.008）,核对后组的中位住院时间和术后住院时间分别为13 d和8d,均较核查前组缩短1d（Z=-4.066,P＜0.01;Z=-5.878,P＜0.01）,多因素Logistic分析显示手术安全核查为影响直肠癌患者术后并发症的独立危险因素（OR =0.761,95％ CI：0.605 ～0.958）.结论 手术安全核查可明显降低直肠癌患者的手术并发症发生率,缩短住院时间,改善患者短期临床结局.Objective To explore the impact of the surgical safety checklist on postoperative clinical outcomes in rectal cancer patients.Methods Data of 2 157 rectal cancer patients undergoing surgery between April 2007 and March 2013 was studied.Patients were divided into two groups according to before or after the time point of April 1,2010,on which the Surgical Safety Checklist was implemented.The clinical outcomes occurring within 30 days after operation were compared between the two groups by chi-square test,independent-samples t test or non-parametric test.Multivariate Logistic regression analysis was performed to identify independent factors.Results The rate of morbidity was 20.38% （191/937） in the pre-implementation group,which was significantly higher than that in the post-implementation one 15.98% （195/1 220） （x2 =6.985,P =0.008）.Median hospital stay and postoperative hospital stay were 13 and 8 days after checklist,which were one day shorter than those observed prior to the checklist （Z =-4.066,P 〈 0.01;Z =-5.878,P 〈 0.01）.Multi-Logistic analysis showed that the Surgical Safety Checklist was an independent factor influencing postoperative complications （OR =0.761,95% CI：0.605-0.958）.Conclusions Implementation of the Surgical Safety Checklist reduces postoperative morbidity and hospital stay and improves clinical outcomes in rectal cancer patients undergoing resection.

关 键 词：直肠肿瘤 安全 核查制度 结果评价 

分 类 号：R735.37[医药卫生—肿瘤]