麻醉恢复室规范化护理管理模式的探讨

目的 保障麻醉恢复期患者的安全,减少并发症的发生,便于连台手术的衔接.方法 某院2002年建立了拥有6张监护床位的麻醉恢复室,参照美国麻醉恢复室的先进护理管理模式,同时结合该院恢复室的运作特点,自行制定了一套规范化的管理模式;加强对护理人员基础理论和专业技能知识培训和考核;要求熟练掌握麻醉恢复期的各种急救技术及监护仪器设备的操作使用;充分合理利用麻醉复苏护士的人力资源;配备完善的监护设备及急救物品.结果 2002年5月-2008年5月,通过对24 408例患者麻醉恢复期的监护,及时发现和处理麻醉后并发症,除102例因病情需要转ICU继续监测治疗外,其余患者平稳度过麻醉恢复期,苏醒后转回原病房.结论 麻醉恢复事的设立,减少了患者在手术室的逗留时间,加快了外科手术的进度,提高了手术室的利用率和工作效率.其科学化、程序化、规范化的管理模式,能有效保障麻醉恢复期患者的安全.     

Missed Nursing Care in the Postanesthesia Care Unit: A Cross-Sectional Study

PurposeThis study aimed to investigate the prevalence, activities, and reasons for missed nursing care in the postanesthesia care unit (PACU) and the effect of intensive care unit (ICU) overflow patients.DesignThis is a single-center, cross-sectional survey.MethodsNineteen PACU-registered nurses of a tertiary care hospital participated. Over a 7-month period, participants were asked to complete a validated questionnaire, which included 19 items related to missed nursing care activities and 10 items related to reasons for missed nursing care. χ² test and 1-way analysis of variance were used for data analysis.FindingsQuestionnaires (N = 397) were completed. Prevalence of missed nursing care activities was 78.1% and was significantly higher in cases of ICU overflow patients (P < .001). The three most reported missed nursing care activities were “drug preparation, administration, and assessment of effectiveness," “patient surveillance and assessment," and “care associated with pain”; prevalence was significantly higher in cases of ICU overflow patients (P = .036, P = .003, and P = .004, respectively). The three most reported reasons for missed nursing care were “inadequate number of nursing personnel," “unexpected rise in patient volume or acuity," and “heavy admission or discharge activity".ConclusionsThe findings indicated missed nursing care was common in the PACU and increased in case of ICU overflow patients. Therefore, missed nursing care needs to be identified and minimized, while the number and length of stay of critically ill patients admitted to the PACU should be limited.     

颅脑手术麻醉后恢复室常见并发症

目的调查颅脑手术患者在麻醉后恢复室（PACU）并发症的发生情况。方法对2009年3月～12月进入PACU的颅脑术后患者2166例进行回顾性分析。结果常见的并发症有高血压（14.0%）、心律失常（13.9%）、疼痛(13.7%)、寒战(10.5%)、恶心呕吐(9.3%)、谵妄躁动(8.6%)。低氧血症(3.4%)、呼吸道梗阻(1.9%)、苏醒延迟(1.5%)、低血压(0.5%)的发生率较低。1例患者发生误吸。并发症总的发生率为52.2%。在监测体温及肌松残余的患者中,体温异常和肌松残余的发生率分别为7.2%和22.8%。全部病例经PACU治疗均恢复正常。结论神经外科PACU的常见并发症有其特殊性,需要针对不同的病种、手术严密观察及时处理。     

Increased Patient Satisfaction in the Postanesthesia Care Unit with the Implementation of a Controlled Noise Reduction Program

PurposeNoise in the postanesthesia care unit (PACU) is a significant source of postoperative patient discomfort and can affect patient sleep and recovery. Interventions involving structural alterations in the environment reduce noise and improve patient satisfaction; however, there are no studies focusing on staff education as a method to reduce PACU noise.DesignWe designed and implemented a prospective PACU noise reduction program using education and training to minimize staff contributions to noise.MethodsNoise levels, measured hourly with a decibel meter, patient satisfaction, and patient rest were assessed before and after implementation.FindingsWe found statistically significant decreases in noise levels and increases in patient satisfaction scores after the implementation of our noise reduction project.ConclusionsThese findings demonstrate that an inexpensive and easily implemented noise reduction program can effectively reduce environmental noise, increase patient satisfaction, and potentially improve recovery.     

A Scoping Review of Intravenous Opioid Pain Protocols and Their Dose-Time Intervals in the Management of Acute Postoperative Pain in the Postanesthesia Care Unit

PurposeThis review aims to explore intravenous opioid pain protocols and their dose-time intervals in managing acute postoperative pain in adults in the postanesthesia care unit (PACU).DesignA scoping review using a systematic search strategy.MethodsSixteen articles were identified from MEDLINE, CINAHL, PubMed, Embase, and Cochrane specific to the aims.FindingsThe literature demonstrated several variations on dose-time intervals used for opioid pain protocol administration globally. Furthermore, opioid analgesic pain protocols in the PACU appear to be effective in postoperative pain management. However, the literature did not identify optimal time intervals related to dose administration within these protocols.ConclusionsLiterature gaps were identified regarding the significance of dose-time intervals when using opioid analgesic pain protocols in the PACU.     

心脏外科ICU患者术后谵妄的危险因素研究

目的 评估心脏外科重症监护病房（CSICU）患者术后谵妄的发生率,分析其危险因素及各危险因素预测术后谵妄发生的效能。方法 采用横断面调查研究法,选取2019年1—5月于某三级甲等综合医院CSICU住院的心脏手术后患者为研究对象。谵妄评估采用ICU患者意识模糊评估法,采用一般资料调查问卷、急性生理和慢性健康评分（Acute Physiology and Chronic Health Evaluation,APACHEⅡ）、中文版重症监护疼痛观察工具、匹兹堡睡眠质量指数量表和ICU环境压力源量表收集资料。采用单因素分析及多因素Logistic回归分析患者术后谵妄的危险因素,利用受试者工作特征曲线（ROC曲线）描述各危险因素的曲线下面积及最佳临界值。结果 （1）共纳入316例患者,发生谵妄81例（25.6%）, Logistic回归分析结果显示,术后谵妄的独立危险因素包括：APACHEⅡ评分（OR=1.257,95%CI为1.018~1.553）,停循环时间>15 min（OR=6.943,95%CI为1.288~37.429）,术后疼痛平均得分（OR=2.918,95%CI为1.749~4.867）,睡眠质量得分（OR=1.147,95%CI为1.038~1.267）,ICU环境压力源得分（OR=1.161,95%CI为1.110~1.214）。（2）ROC曲线结果显示：APACHEⅡ评分、停循环时间>15 min、术后疼痛平均得分、睡眠质量得分、ICU环境压力源得分的曲线下面积分别为0.745、0.617、0.758、0.837、0.910,APACHEⅡ评分、术后疼痛平均得分、睡眠质量得分、ICU环境压力源得分的最佳截断值分别为9分、3分、14分、72分。结论 CSICU患者术后谵妄的发病率处于一个较高水平,APACHEⅡ评分>9分、停循环时间>15 min、术后疼痛平均得分>3分、睡眠质量得分>14分、ICU环境压力源得分>72分的患者更容易发生术后谵妄。本研究为完善CSICU患者术后谵妄的管理提供参考依据。     

A Clinical Update on Delirium: Focus on the Intensive Care Unit Patient

Acute care nurse practitioners manage a wide range of patient diagnoses and problems encountered in critical care, including management of delirium. As such, they are positioned to be leaders in the prevention, recognition, and management of delirium in the intensive care unit setting. Delirium in the hospitalized patient is linked with a prolonged length of stay, higher risk of death, and cognitive decline. Delirium will occur in up to 87% of intensive care unit patients with severe illness or recovering from major surgery. This overview of current evidence-based practice guidelines and an accompanying case study will assist interdisciplinary teams of health care providers to diagnose, treat, and manage hospitalized patients with delirium, with a focus on the complex care of the critically ill patient population.