CAJ | 학술논문

目的探讨在医院船平台应用快捷风险评估(fast risk assessment,FRA)模式行手术风险及早期预后评估的效果.方法 “和平方舟”医院船2013年6月至10月海外医疗服务期间,前瞻性将131例前期筛查有手术指征的外籍患者纳入FRA流程,采用自制FRA表进行术前评估.去除2例梅毒抗体阳性、1例Anti-HIV阳性患者,以及9名极高危患者,共119例患者接受手术治疗.根据分值高低分为低危组(n=51)、中危组(n=45)和高危组(n=23),比较3组年龄构成、手术时间及术后临床指标.结果 3组患者年龄构成、手术及术后恢复临床效果指标比较,差异有统计学意义(P＜0.01).术中情况:3组患者手术持续时间[低危组(39.88±17.85) min,中危组(72.40±19.25) min,高危组(99.56±29.98) min]、平均出血量[低危组(21.96 ± 19.75) ml,中危组(61.56 ±24.19)ml,高危组(87.83±30.96) ml];实施全身麻醉的患者数(低危组2例,中危组11例,高危组l6例)组间比较差异有统计学意义(P＜0.01).术后指标:3组患者围手术期发生高血压(低危组3例,中危组7例,高危组15例)、电解质紊乱(低危组1例,中危组4例,高危组7例)、术后首次下床时间[低危组(2.41±1.68)h,中危组(5.04±1.71)h,高危组(7.30±3.55) h]、平均住院时间[低危组(14.96±8.09)h,中危组(35.87±12.72)h,高危组(46.39±15.98) h]组间比较差异均有统计学意义(P＜0.01).结论快捷风险评估模式是保障医院船平台手术治疗安全有效的可行方法,对提高医院船救治效率、预防涉外医疗不良事件的发生有实用价值.
목적 탐토재의원선평태응용쾌첩풍험평고(fast risk assessment,FRA)모식행수술풍험급조기예후평고적효과.방법 “화평방주”의원선2013년6월지10월해외의료복무기간,전첨성장131례전기사사유수술지정적외적환자납입FRA류정,채용자제FRA표진행술전평고.거제2례매독항체양성、1례Anti-HIV양성환자,이급9명겁고위환자,공119례환자접수수술치료.근거분치고저분위저위조(n=51)、중위조(n=45)화고위조(n=23),비교3조년령구성、수술시간급술후림상지표.결과 3조환자년령구성、수술급술후회복림상효과지표비교,차이유통계학의의(P＜0.01).술중정황:3조환자수술지속시간[저위조(39.88±17.85) min,중위조(72.40±19.25) min,고위조(99.56±29.98) min]、평균출혈량[저위조(21.96 ± 19.75) ml,중위조(61.56 ±24.19)ml,고위조(87.83±30.96) ml];실시전신마취적환자수(저위조2례,중위조11례,고위조l6례)조간비교차이유통계학의의(P＜0.01).술후지표:3조환자위수술기발생고혈압(저위조3례,중위조7례,고위조15례)、전해질문란(저위조1례,중위조4례,고위조7례)、술후수차하상시간[저위조(2.41±1.68)h,중위조(5.04±1.71)h,고위조(7.30±3.55) h]、평균주원시간[저위조(14.96±8.09)h,중위조(35.87±12.72)h,고위조(46.39±15.98) h]조간비교차이균유통계학의의(P＜0.01).결론 쾌첩풍험평고모식시보장의원선평태수술치료안전유효적가행방법,대제고의원선구치효솔、예방섭외의료불량사건적발생유실용개치.
Objective To explore the value of fast risk assessment (FRA) to evaluate surgical risks and predict early prognosis aboard the hospital ship.Methods During the overseas medical service from June to October,2013,"Ark Peace" prospectively put 131 clinical foreign patients with surgical indications on the FRA procedures,and FRA assessment scale was used to make pre-surgical evaluations.With the exclusion of 2 cases of syphilis-antibody positive,one case of Anti-HIV positive and 9 high risk patients,119 patients received surgical treatment.In accordance with the scores,119 post-surgical patients were divided into the lower risk group (n =51),the moderate risk group (n =45) and the high risk group (n =23).Then,therapeutic effects were compared in terms of age composition,surgery and recovery after surgery between the 3 groups.Results Statistical significance could be seen,when comparisons were made in age composition,surgery and recovery after surgery between the 3 groups(P ＜0.01).With respect to surgical data,statistical significance could be seen in the length of surgery,average amount of bleeding and the number of cases performed with general anesthesia,when comparisons were made between the 3 groups(P ＜ 0.01).With respect to post-surgical data,statistical significance could also be seen in the following during the peri-operative period:the incidence of hypertension,electrolyte disturbance,the first time to get out of bed and average length of stay in the hospital,when comparisons were made between the 3 groups (P ＜ 0.01).Conclusions Fast risk assessment was an effective and safe method to ensure surgical treatment aboard the hospital ship.It was of practical value for the promotion of medical care and the prevention of adverse medical events concerning foreign patients aboard hospital ship.