大面积烧伤患者术中多学科协作翻身核查表的编制及应用  

Development and application of multidisciplinary collaboration⁃based perioperative turn⁃over checklist for patients with large area burns

作　　者：尚思雨 倪湘琳 陈芳 郁雪雪 李爽 Shang Siyu;Ni Xianglin;Chen Fang;Yu Xuexue;Li Shuang(Department of Anesthesiology,First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院麻醉学部手术室,上海200433 [2]海军军医大学护理系人文护理学教研室

出　　处：《海军医学杂志》2023年第8期811-816,共6页Journal of Navy Medicine

基　　金：浦东新区卫生健康委员会卫生计生科研面上项目(PW2020A-81)。

摘　　要：目的制定并评价翻身核查表在大面积烧伤患者全身麻醉手术中的应用效果。方法成立多学科研制团队,根据世界卫生组织(WHO)模型,结合文献分析、专家论证和临床模拟制定翻身核查表。本研究共纳入157例全身麻醉术中翻身的烧伤患者,根据手术时间先后分为对照组(采用常规翻身方法,n=76)和观察组(采用翻身核查表指导翻身,n=81)。比较观察组和对照组患者术中翻身时长和不良事件发生率,并通过质性访谈了解手术团队对该核查表的使用体会。结果观察组全身麻醉术中翻身时长[(9.78±1.01)min]明显短于对照组(8.01±0.53)min,差异有统计学意义(P<0.001)。观察组不良事件发生率(2.47%)明显低于对照组(10.53%),差异有统计学意义(P=0.003)。质性访谈显示,使用该核查表能够增强翻身团队人员的信心,提高翻身效率,保障患者安全。结论大面积烧伤患者全身麻醉手术中使用翻身核查表可规范翻身操作流程,缩短术中翻身时间,降低导管扭曲、导管脱落、患者体位偏移等不良事件的发生率,提高大面积烧伤患者的救治效率,提升手术安全性和多学科团队凝聚力,值得临床推广应用。Objective To evaluate the effects of the application of the self‑designed turn‑over checklist in general anesthesia of the patients with large area of burns.Methods A multidisciplinary research team was set up to develop a turn‑over checklist based on the WHO model.In combination of literature review,expert consultation and clinical simulation,the turn‑over checklist was developed.157 burn patients who were turned intraoperatively under sub‑general anesthesia were included in the study and were divided into the control group(using conventional turning method)(n=76)and the observation group(using the turn‑over checklist)(n=81)according to the date of surgery.The duration of intraoperative turning and the rates of adverse events were compared between the patients of the observation and control groups undergoing general anesthesia.Qualitative interviews were made to investigate the checklist application experience of the surgical team.Results The duration of intraoperative turning in the observation group under general anesthesia[(9.78±1.01)min]was significantly shorter than that in the control group[(8.01±0.53)min],with statistical significance(P<0.001).The rate of adverse events in the observation group(2.47%)was significantly lower than that in the control group(10.53%),with statistical significance(P=0.003).Qualitative interviews showed that the application of the turn‑over checklist could enhance the confidence of the surgical team,improve the turning efficiency and ensure patient safety.Conclusion During surgery of the patients with large‑area burns under general anesthesia,the application of the turning checklist to guide the turning over manipulations with rollover bed could standardize the turning over operating procedures,shorten turning over time,improve treatment efficiency,reduce the rates of such side‑effects as catheter distortion,catheter migration,patient position deviation,and improve the safety of operation and cooperative cohesion of multidisciplinary teams.For this reason,it

关 键 词：大面积烧伤 翻身床 核查表 多学科协作 

分 类 号：R612[医药卫生—外科学]