失效模式与效应分析在心外科术后呼吸道感染患者中的应用

目的探讨失效模式与效应分析(FMEA)在心外科术后呼吸道感染患者中的应用效果。方法自2017年成立FMEA团队,选取2015年1月1日-2018年12月31日于某院行心外科手术420例患者作为研究对象,根据入院时间先后分为对照组(2015年1月1日-2016年12月31日共200例)和观察组(2017年1月1日-2018年12月31日共220例)。对照组按照FMEA模式分析心外科术后患者呼吸道感染的主要原因,计算高风险指数(RPN)。观察组根据对照组RPN得分制定实施改进方案,比较2组感染率和RPN得分。结果年龄、机械通气、抑酸药物应用、手术时间、ICU停留时间、体外循环及慢性心功能不全是对照组心外科术后患者发生呼吸道感染的7个重要风险因子。对照组RPN总分为1074分,观察组RPN总分为140分。与对照组比较,观察组RPN总分下降比率为86.96%,改进成效显著。对照组呼吸道感染率为16%(32/200),观察组呼吸道感染率为5%(11/220),与对照组比较,观察组呼吸道感染率降低。结论FMEA模式能够通过对心脏外科手术后患者呼吸道发生风险进行有效量化,医护工作者通过对量化结果进行进一步分析后改进相关医疗措施,显著降低了心脏外科手术后患者发生呼吸道感染的风险。

Application of Failure Mode and Effect Analysis in Patients with Respiratory Tract Infection after Cardiac Surgery

Objectives To investigate the effect of failure mode and effect analysis of(FMEA)in patients with respiratory tract infection after cardiac surgery.Methods The FMEA team was set up in our hospital from 2017,420 patients undergoing cardiac surgery in Hospital January 2015 to December 2018 were selected as the subjects.According to the admission time,they were divided into control group(January 2015 to December 2016,200 cases)and observation group(220 cases from January 2017 to December 2018).In the control group,the main causes of respiratory tract infection after cardiac surgery were analyzed according to FMEA model,and the RPN was calculated.The observation group made an improved plan according to the RPN score of the control group,and compared the infection rate and RPN score between the two groups.Results Age,mechanical ventilation,acid inhibitor use,operation time,ICU residence time,cardiopulmonary bypass and chronic cardiac insufficiency were six important risk factors for respiratory tract infection after cardiac surgery in the control group.Compared with the control group,the total score of RPN in the observation group decreased by 86.96%,and the improvement effect was remarkable.The respiratory rate of respiratory tract in the control group was 16%(32/200),and the infection rate in the observation group was 5%(11/220).Compared with the control group,the respiratory tract infection rate in the observation group was lower than that in the control group.Conclusions The FMEA model can effectively quantify the risk of respiratory tract in patients after cardiac surgery.By further analyzing the quantitative results,the medical measures were improved,which significantly reduced the risk of respiratory tract infection in patients after cardiac surgery.