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      全身麻醉患兒圍術期家庭式管理模式構建
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      發布人:yaot 發布時間:2021/9/9 15:33:56  瀏覽次數:550次
      【字體: 字體顏色

      ——江威 張金萍 田申 趙艾 陶炳東 趙平

      【摘要】依照課題研究型品管圈活動步驟,針對全身麻醉患兒圍術期家庭式管理開展品管圈活動。從術前、術中、術后挖掘全身麻醉患兒圍術期管理現狀水平和攻堅點,多方擬定方策并反復循證,結合現實需求,形成三大方策群組予以實施。通過方策實施,減少了患兒蘇醒期躁動等麻醉并發癥發生,降低了患兒分離恐懼評分,提高了家屬全麻知識知曉率,使患兒和家庭獲益,效果顯著。
      【關鍵詞】品管圈;課題研究型品管圈;全身麻醉;患兒;圍術期;家庭式管理模式
      中圖分類號:R197.323;R726;R614.2文獻標識碼:B
      Development of Family Management Mode for Children under General Anesthesia during Perioperative Period/JIANG Wei,ZHANG Jinping,TIAN Shen,et al.//Chinese Health Quality Management,2021,28(7):80-85
      AbstractAccording to the research quality control circle activity steps, the quality control circle activities were carried out on family management for children under general anesthesia during the perioperative period. From the preoperative, intraoperative and postoperative excavation of children with general anesthesia perioperative management status and key points, multi-formulation and repeated evidence-based strategies, combined with the actual needs, three groups of strategies were developed for implementation. Through the implementation of the strategies, the incidence of anesthesia complications such as agitation during the awakening period of children was reduced, the separation fear score of children was reduced, and the awareness rate of family members on general anesthesia knowledge was improved, benefiting children and their families. The effect was significant.
      Key wordsQuality Control Circle;Research Type Quality Control Circle; General Anesthesia; Children; Perioperative Period; Family Management Mode
      Firstauthor's addressShengjing Hospital, China Medical University, Shenyang, Liaoning, 110004, China


      1 主題選定

      全體圈員采用共識法,對醫院重視程度、迫切性、重要性、圈能力四個維度分別賦予權重;采用頭腦風暴法,列出備選主題;依據“5-3-1”評分法,對所有備選主題進行評價,得分第一順位“全身麻醉患兒圍術期家庭式管理模式構建”被選定為本期活動主題。經QC-Story判定,本期活動主題為課題研究型。
      名詞定義:(1)全身麻醉。簡稱全麻,是指麻醉藥經呼吸道吸入、靜脈或肌肉注射進入體內,產生中樞神經系統的暫時抑制,臨床表現為神志消失、全身痛覺消失、遺忘、反射抑制和骨骼肌松弛等[1]。(2)全身麻醉患兒。指年齡在2周歲~5周歲,施行全身麻醉的小兒患者[2-3]。(3)圍術期。圍繞手術的全過程,包含術前、術中及術后的一段時間,具體是從確定手術治療時起到與這次手術有關治療基本結束為止[4]。(4)家庭式管理(Family-Centered Care,FCC)。指通過家庭和專業人員合作,共同促進孩子健康的一系列護理活動[5]。
      選題背景: 根據WHO-WFSA(World Health Organization-World Federation of Societies of Anaesthesiologists,世界衛生組織-世界麻醉醫師協會聯盟)統計,全球每年小兒患者手術中約有90%實施全身麻醉,僅在美國,每年實施全麻或深度鎮靜的小兒患者達200萬人次[6];我國每年約有800萬~900萬嬰幼圖1模式構建示意圖兒因為手術或診斷性檢查需接受全身麻醉[7]。小兒患者進行全身麻醉極易出現術后精神行為和認知功能改變[8],不僅讓患兒感到不適,而且可能影響患兒情感和認知發育[9],對心理和生理造成長期負面影響。家庭式管理模式起源于美國,于20世紀90年代被引入我國[10]。其核心理念是尊重患兒及家庭,強調以家庭為中心,突出家庭親情在整個疾病治療護理中的作用[11]。有研究[12-14]表明,在手術室,患兒父母陪伴與否是影響患兒蘇醒期是否發生躁動的重要因素。在父母的陪伴下,多數患兒在蘇醒期情緒平靜,能配合醫務人員按指令完成動作,利于醫務人員對患兒清醒程度的判斷,減少患兒蘇醒期躁動發生,保證患兒安全。



      原文鏈接:全身麻醉患兒圍術期家庭式管理模式構建

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