基于599例患者术后自控镇痛泵使用的闭环智能化管理改进措施分析  

Analysis of the improvement measures of closed-loop intelligent management based on the use of postoperative patient-controlled analgesia pump in 599 patients

作　　者：曹璐 张博睿 陈方[2] 梁栋 刘文娟 张鹏[1] 白宁[2] 赵义康 李茁[1] Cao Lu;Zhang Borui;Chen Fang;Liang Dong;Liu Wenjuan;Zhang Peng;Bai Ning;Zhao Yikang;Li Zhuo(Department of Pharmacy,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of Anesthesiology,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of Information Technology,Shaanxi Provincial People's Hospital,Xi'an 710068,China)

机构地区：[1]陕西省人民医院药学部,陕西西安710068 [2]陕西省人民医院麻醉科,陕西西安710068 [3]陕西省人民医院信息科,陕西西安710068

出　　处：《实用药物与临床》2024年第10期767-772,共6页Practical Pharmacy and Clinical Remedies

基　　金：国家卫生健康委医院管理研究所“医疗质量循证管理持续改进研究项目”(YLZLXZ23G023);陕西省人民医院科技人才支持计划项目(2021JY-30)。

摘　　要：目的了解我院术后自控镇痛(Patient controlled analgesia,PCA)泵的使用现状,明确PCA泵使用过程中具体存在的问题,并提出改进措施。方法采用回顾性调查方法,选取2023年6-12月于我院行手术且术后使用PCA泵的患者,记录其基本信息、临床诊断、手术类型、PCA泵的使用情况等,进行统计分析。结果共纳入599例术后使用PCA泵的患者,66例患者(11.02%)使用硬膜外自控镇痛(Patient-controlled epidural analgesia,PCEA)泵进行术后镇痛,其镇痛效果与静脉自控镇痛(Patient-controlled intravenous analgesia,PCIA)泵(533例,88.98%)比较,差异无统计学意义(P>0.05);82.80%的PCA泵的配方为阿片类药物联合非甾体抗炎药(Nonsteroidal anti-inflammatory drugs,NSAIDs);镇痛泵中也存在不合理用药现象,主要表现为两种NSAIDs联用,或阿片受体的纯激动剂与激动-拮抗剂联用;417例患者(69.62%)对镇痛泵均进行了有效按压,但仍有182例患者(30.38%)在使用PCA泵的过程中存在无效按压情况;仅39例患者(6.51%)将PCA泵中药液使用完全,其余患者的PCA泵中存在残余药液,残余率主要为1%~20%(288例,48.08%),但该部分残余药液的临床处置欠规范,存在安全隐患;绝大多数患者在使用PCA泵过程中,医生、护士或药师未规范进行疼痛评估及记录不良反应的发生情况。结论基于无线镇痛管理系统软件的镇痛泵闭环和智能化管理中仍存在不合理的现象,应及时改进,并持续监测和评估改进效果,不断完善镇痛泵的闭环智能化管理,保障其使用的有效性和安全性。Objective To understand the current situation of the use of postoperative patient-controlled analgesia(PCA)pumps in our hospital,identify the specific problems in the use of PCA pumps,and propose improvement measures.Methods A retrospective survey was used to select the patients who were admitted to our hospital for operation and used PCA pumps after operation from June to December 2023.Their basic information,clinical diagnosis,surgical type,and PCA pump usage were recorded for statistical analysis.Results A total of 599 patients who used PCA pumps after operation were included.Totally 66 patients(11.02%)used PCEA pumps for postoperative analgesia,and there was no significant difference in its analgesic effect compared with PCIA pumps(533 cases,88.98%);82.80%of PCA pumps used the formular of opioid drugs combined with non-steroidal anti-inflammatory drugs(NSAIDs);there was also irrational drug use in PCA pumps,mainly manifested as the combination of two NSAIDs,or the combination of pure agonists and mixed agonists-antagonists of opioid receptors;417 patients(69.62%)performed effective compression of PCA pumps,but 182 patients(30.38%)still had ineffective compression during the use of PCA pumps;only 39 patients(6.51%)used PCA pumps completely,while the remaining patients had residual drug solutions in their PCA pumps,with residual rates mainly in the range of 1%~20%(288 cases,48.08%),however,the clinical disposal of the residual drug solution was not standardized and there were potential safety hazards;the vast majority of patients did not receive the standardized pain assessment and the occurrence of adverse drug reactions during the use of PCA pumps was not recorded by doctors,nurses,or pharmacists.Conclusion There are still unreasonable phenomena in the closed-loop and intelligent management of analgesic pumps based on wireless analgesic management system software,and they should be improved in a timely manner.The improvement effect should be continuously monitored and evaluated.The closed-loop intelligent man

关 键 词：自控镇痛泵 闭环管理 智能化管理 改进措施 

分 类 号：R614[医药卫生—麻醉学]