JAMA:麻醉交接,马虎不得!30 万台手术资料显示,手术中更换麻醉师明显增加术后死亡和并发症等风险

2018-01-25 佚名 奇点网

“所谓的岁月静好,不过是因为有人默默守护。”见证一幕幕悲喜的手术室门外,患者和家属们只能见到主刀医生的身影,而默默守护着手术顺利进行,让病人不会感到疼痛的麻醉医生们的努力,只有无影灯和手术麻醉记录作证了。

“所谓的岁月静好,不过是因为有人默默守护。”见证一幕幕悲喜的手术室门外,患者和家属们只能见到主刀医生的身影,而默默守护着手术顺利进行,让病人不会感到疼痛的麻醉医生们的努力,只有无影灯和手术麻醉记录作证了。

很多人以为,麻醉医生的工作无非就是给需要手术的患者打一针,这可就大错特错了。术前对患者状况的评估,术中对患者片刻不离的照看,术后等待患者醒来的监护,哪里少得了麻醉医生的身影?看到患者在术后平安醒来的那一刻,麻醉医生们的辛劳就有了意义,这也算是深藏功与名了。

患者失去意识前,最后看到的往往正是麻醉医生的脸

近日发表在 JAMA 上的一项研究,再次强调了麻醉医生的无声责任有多重大:加拿大研究团队对 30 余万例大手术患者资料进行的分析显示,手术中进行麻醉师的完全交接,会使术后 30 天内的全因死亡风险、严重并发症、再次入院等多种事件发生率上升 15%!

伴随着麻醉医生的除了重大的责任,还有极高的工作压力。虽然论工作强度,麻醉医生肯定不如操刀上阵的外科医生们,但麻醉医生的工作时间相当长,一天参与数台大手术、十几台小手术都有可能,而且我国每万人配备的麻醉医生仅约为 0.5 名,是欧美国家的五分之一,人才缺口巨大。

人毕竟不是机器,十几个小时的工作不累是不可能的。手术中更换麻醉医生并不少见,但在手术室紧张和快节奏的环境中,说交接班 100% 不出差错肯定不现实,如果在疲劳等因素的影响下,交班医生没有向接班医生详细交代患者状况,就存在了手术风险的隐患。


虽说理想状态的手术室是各司其职井然有序,但理想和现实还是有落差的……

麻醉师交个班真有多大影响吗?得拿数据说话。加拿大西安大略大学的研究团队收集了整个安大略省 1400 万居民(约占全加拿大 40%)2009-2015 年间的大手术(手术时间 2 小时以上,术后患者至少住院一天)资料,范围涵盖了神经、心胸、腹部、泌尿等众多科室,研究的终点设定为术后 30 天内患者因各种原因死亡、因手术再次住院和术后出现严重并发症三项不良事件。

在研究分析的 30 余万台手术中,有占总数约 2% 的 5947 台手术进行了术中麻醉交接,而这些患者出现上述三种不良结果的比例达到 44%,比不交接手术的患者高出 14.1%!调整各种相关因素后的统计分析显示,术中麻醉交接会使患者术后死亡和出现严重并发症的风险上升 7%,同时也会延长患者的再次住院时间!不过在住院频率上,麻醉交接并没有显著影响。


麻醉交接,影响真的一点都不小

论文通讯作者 Philip Jones 教授表示:“手术中的麻醉交接可能出于疲劳、生病、换班等各种原因,麻醉医生们往往认为,只要交接班医生间进行了充分的信息沟通,就不会产生影响,但我们的研究显示这种观念可能有误,因此也许应该考虑限制手术中的麻醉医生换人。”

但在 JAMA 同期配发的社论中,密歇根大学的两位教授却表示了异议。“虽然研究证实了麻醉交接与不良预后存在关联,但以此建议减少交接并不是一种彻底解决问题的方法,我们应该关注的是优化医生的沟通,采用更加规范的流程、工具和技术手段取代记忆进行交接班。”2013 年,JAMA 上的一项研究就显示,规范手术医生的交接流程可以显著减少手术中失误和不良事件的发生率。

手术室里无小事,用复旦大学附属肿瘤医院麻醉科缪长虹教授的话说:诗和远方,对麻醉医生而言是一种奢侈。虽然有不少医生半开玩笑地说,麻醉师推完针之后的工作就变成了摆弄手机、每日股票动态和八卦分析,但 JAMA 社论中的结语却是掷地有声:“Patients deserve nothing less.”

小编觉得,面对麻醉交接的风险,医生们应该把这当成再次提高手术质量的突破口。一切以病人利益至上,才是真正的医者父母心,不是吗?

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    2018-12-07 wshxjq
  2. [GetPortalCommentsPageByObjectIdResponse(id=1822487, encodeId=7977182248ea3, content=<a href='/topic/show?id=cb3b1030603e' target=_blank style='color:#2F92EE;'>#麻醉师#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103060, encryptionId=cb3b1030603e, topicName=麻醉师)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd34186, createdName=wshxjq, createdTime=Fri Dec 07 18:08:00 CST 2018, time=2018-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=290370, encodeId=e8882903e0df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sat Feb 24 06:28:32 CST 2018, time=2018-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757930, encodeId=f5881e5793093, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Sun Apr 08 13:08:00 CST 2018, time=2018-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=283258, encodeId=f88e28325891, content=好好好学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Mon Jan 29 18:12:22 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=281916, encodeId=a45a28191636, content=工作认真仔细.避免凤险., beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Jan 25 16:14:27 CST 2018, time=2018-01-25, status=1, ipAttribution=)]
    2018-02-24 秀红

    学习了

    0

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    2018-04-08 丁鹏鹏
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    2018-01-29 zwjnj2

    好好好学习学习学习

    0

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    2018-01-25 1e0f8808m18(暂无匿称)

    工作认真仔细.避免凤险.

    0

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