基于多学科团队协作的手术室流程优化在胃肠道手术中的应用  

Observation of application of optimized operating room processes based on multidisciplinary team collaboration in gastrointestinal surgery

作　　者：刘畅[1] 曾志军[1] 杨浩[1] 曹畅[2] 唐朝辉[3] 张芳昉[3] 周承汇 张宇[1] 王承宇 贺吉群[2] 吴畏[1] LIU Chang1, ZENG Zhijun1, YANG Hao1, CAO Chang1, TANG Zhaohui3, ZHANG Fangfang3, ZHOU Chenghui1, ZHANG Yu1, WANG Chengyu1, HE Jiqun2, WU Wei1(1. Department of Geratic Surgery; 2. Operating Room ;3. Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha 410008, China)

机构地区：[1]中南大学湘雅医院老年外科,湖南长沙410008 [2]中南大学湘雅医院手术室,湖南长沙410008 [3]中南大学湘雅医院麻醉科,湖南长沙410008

出　　处：《中国普通外科杂志》2018年第9期1167-1172,共6页China Journal of General Surgery

摘　　要：目的:探讨胃肠道手术手术室术前流程的优化及应用价值。方法:选择125例行肠道手术的患者,其中35例手术开始前采用了经麻醉医生、外科医生、手术室护士讨论后确立的协作优化措施(优化组),90例手术开始前采用常规流程(常规组),分析两组患者的手术室监控录像回放资料。结果:无论区分或不区分手术体位,优化组患者从麻醉诱导开始至手术开始之间的准备时间均较常规组明显减少(均P<0.05)。仰卧位手术中,采用优化措施患者的麻醉诱导开始至导尿开始、导尿结束至消毒开始、铺单结束至手术开始所用时间均明显优于采用常规措施患者(均P<0.05);截石位手术中,采用优化措施患者的麻醉诱导开始至摆放体位、摆放体位结束至消毒开始、铺单结束至手术开始所用时间均明显优于采用常规措施患者(均P<0.05)。结论:所建立的多学科团队协作优化措施可明显缩短各操作之间的衔接时间及患者麻醉时间,从而提高手术室利用效率。Objective： To investigate the optimization of preoperative preparation processes in the operating room and its application value in gastrointestinal surgery. Methods： One hundred and twenty five patients undergoing gastrointestinal surgery were selected. Before the start of surgery, 35 cases received the collaborative optimization measures that were established after discussion among anesthesiologists, surgeons and operating room nurses （optimization group）, while 90 cases received the conventional approaches （conventional group）. The playback data from the video surveillance cameras of the operating room of the two groups of patients were analyzed. Results： Regardless of whether dividing the operative positions or not, the preparation times from the initiation of induction of anesthesia to the start of surgery in optimization group were all significantly shorter than those in conventional group （all P〈O.OS）. In supine position surgery, the times from initiation of induction of anesthesia to start of urinary catheterization, from the end of urinary catheterization to start of operation site disinfection, and from completion of draping to start of surgery in patients receiving optimization measures were all significantly superior to those receiving conventional approaches （all P〈O.OS）; in lithotomy position surgery, the times from initiation of induction of anesthesia to patient positioning, from end of patient positioning to start of operation site disinfection, and from completion of draping to start of surgery in patients receiving optimization measures were all significantly superior to those receiving conventional approaches （all P〈0.05）. Conclusion： The established optimization measures based on multidisciplinary team collaboration can help to reduce the changeover times between processes and time for inducing anesthesia, and thereby boost the efficiency of the operating room.

关 键 词：消化系统外科手术 手术室 临床路径 快速康复外科 

分 类 号：R612[医药卫生—外科学]