国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2013年
16期
2572-2575
,共4页
麻醉风险%麻醉质量%评估
痳醉風險%痳醉質量%評估
마취풍험%마취질량%평고
Anesthesia risk%Anesthesia quality%Evaluation
目的 建立一整套完善具体的麻醉风险与质量评估学理论体系,从回避麻醉风险及事故的角度分析总结经验教训以提高麻醉质量减少并发症及事故的发生并为麻醉学建立一门能客观预估麻醉风险和提高麻醉质量的二级学科.方法 收集本医院近二十年各种不同类型麻醉病例,尤其对急、危、重、罕见、抢救病例进行评估、反思、总结其麻醉质量、麻醉经验和风险；收集本省市及本医院近二十年各种不同类型麻醉事故/并发症/麻醉赔偿官司并进行评估、反思、总结其经验教训.结果 106例麻醉导致脑死亡(植物人)其主要原因是手术中低血压、低血氧或心跳骤停时间过长、抢救不及时或麻醉复苏清醒评分不足导致,75例麻醉截瘫和马尾综合征其主要原因是病人过胖过矮致摸不清椎体间隙且穿刺粗暴或穿刺点过高,也有3例因用药错误或不慎导致麻醉死亡病例,有4例因术前谈话不充分导致赔偿个案,有56例因术中大出血抢救无效死亡及困难插管导致死亡.结论 发现容易出事故和风险的情形很容易再次出现,即重复相同原因出现相同的差错和事故,有必要建立一整套麻醉风险与质量评估的理论指导体系,有必要为麻醉学建立一门能客观预估麻醉风险和提高麻醉质量远离麻醉事故的二级学科-麻醉风险与质量评估学.
目的 建立一整套完善具體的痳醉風險與質量評估學理論體繫,從迴避痳醉風險及事故的角度分析總結經驗教訓以提高痳醉質量減少併髮癥及事故的髮生併為痳醉學建立一門能客觀預估痳醉風險和提高痳醉質量的二級學科.方法 收集本醫院近二十年各種不同類型痳醉病例,尤其對急、危、重、罕見、搶救病例進行評估、反思、總結其痳醉質量、痳醉經驗和風險；收集本省市及本醫院近二十年各種不同類型痳醉事故/併髮癥/痳醉賠償官司併進行評估、反思、總結其經驗教訓.結果 106例痳醉導緻腦死亡(植物人)其主要原因是手術中低血壓、低血氧或心跳驟停時間過長、搶救不及時或痳醉複囌清醒評分不足導緻,75例痳醉截癱和馬尾綜閤徵其主要原因是病人過胖過矮緻摸不清椎體間隙且穿刺粗暴或穿刺點過高,也有3例因用藥錯誤或不慎導緻痳醉死亡病例,有4例因術前談話不充分導緻賠償箇案,有56例因術中大齣血搶救無效死亡及睏難插管導緻死亡.結論 髮現容易齣事故和風險的情形很容易再次齣現,即重複相同原因齣現相同的差錯和事故,有必要建立一整套痳醉風險與質量評估的理論指導體繫,有必要為痳醉學建立一門能客觀預估痳醉風險和提高痳醉質量遠離痳醉事故的二級學科-痳醉風險與質量評估學.
목적 건립일정투완선구체적마취풍험여질량평고학이론체계,종회피마취풍험급사고적각도분석총결경험교훈이제고마취질량감소병발증급사고적발생병위마취학건립일문능객관예고마취풍험화제고마취질량적이급학과.방법 수집본의원근이십년각충불동류형마취병례,우기대급、위、중、한견、창구병례진행평고、반사、총결기마취질량、마취경험화풍험；수집본성시급본의원근이십년각충불동류형마취사고/병발증/마취배상관사병진행평고、반사、총결기경험교훈.결과 106례마취도치뇌사망(식물인)기주요원인시수술중저혈압、저혈양혹심도취정시간과장、창구불급시혹마취복소청성평분불족도치,75례마취절탄화마미종합정기주요원인시병인과반과왜치모불청추체간극차천자조폭혹천자점과고,야유3례인용약착오혹불신도치마취사망병례,유4례인술전담화불충분도치배상개안,유56례인술중대출혈창구무효사망급곤난삽관도치사망.결론 발현용역출사고화풍험적정형흔용역재차출현,즉중복상동원인출현상동적차착화사고,유필요건립일정투마취풍험여질량평고적이론지도체계,유필요위마취학건립일문능객관예고마취풍험화제고마취질량원리마취사고적이급학과-마취풍험여질량평고학.
Objective To establish a detailed anesthesia risk and quality evaluation system for the decrease of the incidence of anesthesia accident and to establish a second-class subject of predicting anesthesia risk and anesthesia quality.Methods We collected the anesthesia cases of The Third Affiliated Hospital of Guangzhou Medical College in recent 20 years,analyzed and summarized the anesthesia risk,quality and experience for the anesthesia cases in particular the emergent,critical,severe,seldom-seen,and rescued ones.The anesthesia accidents and anesthesia complications in our hospital as well as the anesthesia lawsuit concerning claiming for compensation in Guangdong province were also analyzed.Results 106 anesthesia-induced brain death (vegetative state) cases were mainly caused by hypotension and low blood oxygen,failure in rescue for long-time cardiac arrest or inadequate anesthesia resuscitation-consciousness,75 anesthesia-induced paraplegia and cauda equina syndrome cases were mainly caused by mistaken location of intra-vertebral space in the fatter or shorter cases or violent puncturation,3 cases were dead for the mistaken medication,4 cases claimed for compensation for improper preoperative conversation,and 56 death cases were induced by operative hemorrhea and having difficulties in intubation.Conclusion Anesthesia accident and risk usually recur under the same situation,and so it is necessary to establish a detailed anesthesia risk and quality evaluation system and the second-class subject of predicting anesthesia risk and anesthesia quality for avoiding anesthesia accident.
