失效模式与效应分析在全麻下截石位并发症风险防范中的应用

周胤婵; 徐小娟; 刘卉蓉; 李城女; 李定; 张乐逸

doi:10.16766/j.cnki.issn.1674-4152.003611

失效模式与效应分析在全麻下截石位并发症风险防范中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003611

浙江省人民医院淳安分院健康管理中心，浙江杭州 311700

基金项目:

浙江省医药卫生科技计划项目 2022ZH008

杭州市医药卫生科技计划项目 B20210593

详细信息

通讯作者:
周胤婵，E-mail：13989863478@163.com

中图分类号: R614.2 R473.6
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- 文章访问数: 147
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- 被引次数: 0
出版历程
- 收稿日期: 2023-09-28
- 网络出版日期: 2024-09-05

Application of failure mode and effect analysis in risk prevention of complications at lithotomy site under general anesthesia

Department of Health Management Center, Chun ' an Branch of Zhejiang Provincial People ' s Hospital, Hangzhou, Zhejiang 311700, China

摘要

摘要: 目的为降低临床全麻下截石位手术患者手术相关并发症的发生风险，本研究将失效模式与效应分析(FMEA)应用于全麻下截石位手术中并探讨其在防范全麻下截石位并发症中的临床价值。方法纳入2022年1—9月浙江省人民医院淳安分院健康管理中心采用常规防范模式防范全麻下截石位并发症的200例截石位手术患者作为对照组；2022年10月—2023年6月采用FMEA护理模式防范全麻下截石位并发症的200例截石位手术患者作为观察组。比较2组患者手术体位相关并发症发生率、患者舒适度及医生满意度。结果观察组患者下肢静脉血栓形成率为2.00%(4/200)，小腿筋膜室高压综合征发生率为1.50%(3/200)，均低于对照组[6.00%(12/200)、5.50%(11/200)]，差异有统计学意义(χ²=4.167、4.737，P < 0.05)；观察组循环系统变化发生率、周围神经损伤发生率低于对照组，但差异无统计学意义(P>0.05)。观察组患者舒适度高于对照组(P < 0.05)。观察组医生对患者操作安全性的满意度评分高于对照组(P < 0.05)；观察组与对照组手术等待时间满意度评分比较，差异无统计学意义(P＞0.05)。结论 FMEA护理模式可有效降低全麻下截石位手术体位相关并发症发生率，提高患者舒适度，同时还可提升医生对患者操作安全性的满意度，值得在临床中推广应用。
- 失效模式与效应分析 /
- 全身麻醉 /
- 截石位 /
- 并发症
Abstract: Objective In order to reduce the risk of operation-related complications in patients undergoing lithotomy under general anesthesia, this study applied failure mode and effects analysis (FMEA) to lithotomy under general anesthesia, and explored its clinical value in preventing the risk of complications in lithotomy under general anesthesia. Methods From January 2022 to September 2022, 200 patients who underwent lithotomy under general anesthesia in the normal mode at the Health Management Center of Chun ' an Branch of Zhejiang Provincial People ' s Hospital, were selected as the control group. From October 2022 to June 2023, 200 patients who underwent lithotomy under general anesthesia in the FMFA mode were enrolled in the observation group. The incidence of complications related to surgical position, patient comfort, and doctor satisfaction between the two groups were compared. Results The incidence rates of venous thrombosis and fascial compartment hypertension in the observation group were 2.00% (4/200) and 1.50% (3/200), respectively, which were lower than those in the control group [6.00% (12/200), 5.50% (11/200), χ²=4.167, 4.737, P < 0.05]. However, the incidence of circulatory system changes and peripheral nerve injury in the observation group were lower than that in the control group, with no significant difference (P>0.05). The comfort level of the patients in the observation group was higher than that in the control group (P < 0.05). The satisfaction score of doctors in the observation group was higher than that in the control group (P < 0.05). There was no significant difference between the observation group and the control group in the satisfaction score of waiting time for surgery (P>0.05). Conclusion FMEA nursing mode effectively reduces complications related to the position of lithotomy under general anesthesia, improves the comfort of patients, and boosts the satisfaction of doctors with patient safety during surgery. Its widespread application in clinics is highly recommended.
- Failure mode and effects analysis /
- General anesthesia /
- Lithotomy position /
- Complication

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表 1 常规泌尿外科截石位摆放流程表

Table 1. Flowchart of routine urological lithotomy position

主流程	子流程
1准备	1.1护士人员准备：着装干净整洁、口罩帽子佩戴符合要求。
1准备	1.2用物准备：包括托腿架、小软垫、凝胶垫、托手架、布单、约束带。
2评估	2.1评估患者皮肤情况是否完好。
	2.2评估患者肢体关节活动度是否良好。
	2.3评估手术床功能是否良好。
3操作步骤	3.1正确放置托手架位置，并附上盖布单。
	3.2正确放置托腿架位置，其上放置凝胶垫。
	3.3平移患者臀部尽量移于手术台脚板下折床边缘处。
	3.4调整患者两腿外展，使之夹角 < 90°，放置于托腿架上，凝胶垫保护腘窝处，防止皮肤软组织损伤。
	3.5调整膝关节弯曲角度使之自然下垂，约束带固定，约束带松紧适宜，防止皮肤软组织损伤。
	3.6臀部下垫凝胶垫，防止皮肤软组织损伤。
	3.7调节托手架合适位置，外展输液侧手臂，双上肢约束带固定，松紧适宜，防止皮肤软组织损伤。
	3.8取下手术脚板，根据手术需求调节手术床角度，减轻肩颈部压力。
	3.9避免皮肤直接接触金属及橡胶部分，防止皮肤软组织损伤。
	3.10操作中动作轻柔，避免过多暴露，注意保护患者隐私。

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表 2 全麻下截石位并发症FMEA分析

Table 2. FMEA analysis of complications in stone position under general anesthesia

流程步骤	失效模式	失效原因	改进措施	风险分析(分)
流程步骤	失效模式	失效原因	改进措施	S	O	D	RPN
1评估	A风险评估不全面，缺乏对患者心功能、体重、营养状态等的评估	①风险的评估无依据、不规范	构建全麻下截石位并发症预警机制，并进行统一培训	4.34	8.23	8.12	301.80
3操作步骤	B存在神经损伤风险	②缺乏术后体位转换方法	完善相关内容及培训	3.78	7.12	8.78	240.67
		③缺乏体位摆放时机的选择	加强相关体位摆放时机培训及最新知识指导	5.89	7.78	6.12	285.23
		④缺乏手术人员操作规范	使用专用警示标识，粘贴在手术室	5.56	5.23	5.56	165.67
	C术后肩颈痛	⑤缺乏冲洗过程体位调整操作方法	加强相关内容培训	4.78	8.12	6.56	259.67

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表 3 2组行截石位手术患者一般资料比较

Table 3. Comparison of general data between two groups in patients undergoing lithotomy

组别	例数	性别[例(%)]		年龄 (x±s, 岁)	BMI (x±s)
组别	例数	男性	女性
对照组	200	108(54.00)	92(46.00)	41.7±7.2	25.7±2.1
观察组	200	116(58.00)	84(42.00)	41.5±7.3	26.1±3.0
统计量	0.649^a			0.276^b	1.545^b
P值	0.420			0.783	0.123
注：^a为χ²值，^b为t值。

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表 4 2组行截石位手术患者并发症发生情况比较[例(%)]

Table 4. Comparison of complications between two groups [cases(%)]

组别	例数	下肢静脉血栓形成	循环系统变化	周围神经损伤	小腿筋膜室高压综合征
对照组	200	12(6.00)	5(2.50)	6(3.00)	11(5.50)
观察组	200	4(2.00)	0	2(1.00)	3(1.50)
χ²值		4.167	3.241	1.148	4.737
P值		0.042	0.072	0.284	0.030

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表 5 2组行截石位手术患者舒适度比较[例(%)]

Table 5. Comparison of comfort level between two groups in patients undergoing lithotomy [cases(%)]

组别	例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级
对照组	200	68(34.00)	90(45.00)	36(18.00)	6(3.00)
观察组	200	155(77.50)	42(21.00)	3(1.50)	0
注：2组患者舒适度比较，Z=9.023，P < 0.001。

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表 6 2组行截石位手术医生满意度评分比较(x±s, 分)

Table 6. Comparison of satisfaction scores between two groups in doctors performed lithotomy (x±s, points)

组别	例数	手术等待时间	对患者操作安全性
对照组	200	89.21±7.63	90.24±8.15
观察组	200	90.14±8.26	92.43±7.37
t值		1.170	2.819
P值		0.243	0.005

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