Abstract:Objective To explore the application effect of resuscitation management scheme based on situation-background-assessment-recommendation(SBAR)communication mode and dynamic scheduling in patients after general anesthesia.Methods A total of 200 patients,aged 18-80 years,of American Society of Anesthesiologists(ASA)physical status ⅡorⅢ,admitted to postanesthesia care unit(PACU)after general anesthesia at the People's Hospital of Guangxi Zhuang Autonomous Region,from August 2023 to July 2024 were selected as research objects.According to convenience sampling method,the patients who admitted to PACU from August 2023 to February 2024 were selected as the control group(n=100).Those who admitted to PACU from March 2024 to July 2024 were selected as the experimental group(n=100).The control group was given routine resuscitation measures,and the experimental group was given resuscitation management scheme based on SBAR communication mode and dynamic scheduling.The occurrence of complications and nursing adverse events during the recovery period were compared between the two groups.Results The incidence of postoperative complications such as agitation,nausea and vomiting,hypoxemia and delayed transfer in the experimental group were significantly lower than those in the control group,with statistically significant difference(P＜0.05).The incidence of nursing adverse events such as unclear skin handover,urinary catheter problems,and nursing record errors in the experimental group was lower than that in the control group,with statistically significant difference(P＜0.05).Conclusion The resuscitation management scheme based on SBAR communication mode and dynamic scheduling can effectively reduce the risk of complications and nursing adverse events during the recovery period of patients after general anesthesia,optimize the resuscitation process,improve the quality of resuscitation,and has good clinical promotion value.
Abstract:Objective To investigate risk factors for postoperative myocardial injury in diabetic patients and construct a predictive model for myocardial injury after non-cardiac surgery(MINS)in diabetic patients through the integration of coronary computed tomography angiography(CCTA)anatomical features and perioperative clinical indicators.Methods A retrospective analysis was conducted on 242 diabetic patients who underwent non-cardiac surgery and preoperative CCTA within six months at Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 1st to September 30th,2023.Patients were classified into MINS group(n=54)and non-MINS group(n=188),according to whether MINS occurs.LASSO regression and multivariable logistic regression were used to identify risk factors for postoperative myocardial injury in diabetic patients,followed by nomogram construction.Results LASSO regression identified left anterior descending lesions,diuretic dosage,number of diseased vessels,coronary stent history,anemia,total cholesterol,and systolic blood pressure as key predictors.Multivariable logistic regression confirmed left anterior descending lesions(OR=2.49,95%CI 1.24-5.04,P=0.011),coronary stent history,diuretic dosage,systolic blood pressure,and anemia as independent risk factors.The nomogram demonstrated good discrimination(AUC=0.778,95%CI 0.709-0.847;sensitivity=0.702,specificity=0.686)and internal validation consistency(mean bootstrapped AUC=0.765,95%CI 0.738-0.782).Hosmer-Lemeshow test indicated adequate calibration(χ2=11.416,P=0.179).Decision curve analysis(DCA)revealed superior net benefit within a threshold probability range from 0.1 to 0.9.Conclusion Left anterior descending lesions are predictive of MINS in diabetic patients.The integrated model combining perioperative factors effectively stratifies MINS risk in diabetic patients.
Abstract:In recent years,with the intensification of population aging and the increase in the number of patients with chronic diseases,the demand for medical services has been continuously growing.However,the traditional medical service model has shortcomings in pain management,resulting in poor patient experience,especially pain during surgery and examination,which is often ignored or underestimated.The core concept of"pain-free hospital"is to provide patients with painless medical services through optimizing the medical service process,improving the level of medical technology,and strengthening multidisciplinary collaboration.At present,the construction of"pain-free hospital"still faces deficiencies under the model of medical union.Combining literature analysis and clinical practice,this paper aims to provide countermeasures for the construction of"pain-free hospital"under the medical union model,enhance patient satisfaction,improve medical service level,and better perfect the construction system of"pain-free hospital"of medical union.
Abstract:Objective To compare the lung protective effects of lung recruitment maneuver(RM)using the positive end-expiratory pressure(PEEP)increment method guided by lung ultrasound score(LUS)and the controlled inflation(SI)method in children with congenital heart disease(CHD)undergoing cardiopulmonary bypass(CPB)surgery.Methods A total of 84 children,aged 5 to 63 months,of American Society of Anesthesiologists(ASA)physical status Ⅰ or Ⅱ,scheduled for CPB-assisted CHD correction surgery at Henan Children's Hospital from December 2023 to February 2025 were randomly divided into the controlled inflation RM group(control group,n=42)and the PEEP increment RM group(experimental group,n=42).LUS,hemodynamic parameters,blood gas indicators,dynamic lung compliance,serum inflammatory factors[IL-6,TNF-α,procalcitonin(PCT)],postoperative pulmonary complications,extubation time,and hospital stay were compared before anesthesia induction(T0),before RM after tracheal intubation(T1),after RM after tracheal intubation(T2),before RM at the end of surgery(T3),after RM at the end of surgery(T4),at 24 h after surgery(T5),and 48 h after surgery(T6).And for each indicator at the T5 time point,stratified comparisons were conducted based on age(＜1-year-old infants and≥1-year-old toddlers).Results Compared with the control group,the experimental group had lower LUS scores and heart rate(HR)and higher mean arterial pressure(MAP)at T2,T4,T5,and T6(P＜0.05);significantly higher dynamic lung compliance at T2 and T4(P＜0.01);lower IL-6,TNF-α,and PCT levels at T3,T5,and T6(P＜0.05);higher arterial partial pressure of oxygen(PaO2)and oxygenation index(OI)at T2,T4,T5,and T6(P＜0.05 or P＜0.01);lower PPC incidence(P＜0.05);shorter extubation time(P＜0.05);and significantly shorter hospital stay(P＜0.01).Subgroup analysis showed that at T5,LUS,IL-6,PCT,and extubation time in the infant subgroup of the experimental group were lower than those in the child subgroup,while dynamic lung compliance was higher and OI was lower(P＜0.05).Conclusion LUS-guided PEEP increment RM has a significant lung protective effect in children with CHD undergoing CPB surgery,improving oxygenation,stabilizing hemodynamics,reducing inflammatory response,lowering postoperative pulmonary complications,and promoting postoperative recovery,with better effects in infants＜1 year old.
Abstract:Objective To explore the intelligent paradigm in improving the safety and quality of analgesia.Methods Addressing the current uncertainty and challenges that patients and anesthesiologists are facing and how to improve inadequate postoperative pain control.We have introduced an innovative wireless analgesia management system (WAMS), which utilizes the internet composite information to fulfill the task of intelligent patient controlled analgesia (PCA).Based on the WAMS, information was gathered on the mandatory daily rounds by the anesthesiologists and anesthesia nurses in the first three days after surgery, which was analyzed and processed to develop the intelligent management postoperative model (IMPA).In the system, the analgesic effectiveness was recorded in detail as a reference for quality control.Our study proposed that both WAMS and medical professional mandatory daily assessments are the fundamental and indispensable approach to ensure the safety and quality of analgesia in the immediate postoperative period.They are also the motivational driving forces for the advancement of anesthesiology.Results WAMS has been implemented in more than 200 hospitals in China and has formed a solid platform and an excellent mode of analgesia management practice with promising clinical outcomes.The current WAMS database analysis suggests: The rate of resting NRS≥4 was 0.48%;the rate of activity NRS≥4, ≥5 and ≥7 were 22.75%, 6.26% and 0.37% respectively.With combined incidence of nausea and vomiting was 8.36%, vomiting incidence was only 4.89%.The rate of a patient′s experience that was being inadvertently sedated was roughly 4.6%, while moderate sedation was only 0.37%, whereas severe sedation was 0.09%.The overall patient′s satisfaction was 100%.Conclusion Implementation of WAMS proved to be well organized, efficacious, and safe.WAMS database can be a valuable resource to improve the safety and quality of postoperative analgesia.IMPA is an encouraging practice pathway for implementation.
Abstract:Perioperative pain management is one of the key factors to enhanced recovery after surgery (ERAS).Based on ERAS and intelligent postoperative analgesia management system, comprehensive goal-directed perioperative analgesia (CGPA) was proposed, including the following five aspects: (1) preventive analgesia before surgery, (2) intraoperative nociceptive stress and damage control, (3) transitional period analgesia from the end of surgery to the recovery of anesthesia, (4) postoperative analgesia and (5) pain management after the removal of analgesic pump.Through the establishment of acute pain management service group and the application of information technology and multi-modal andgesia, the individual level of perioperative analgesia was continuously improved, which helps to achieve the aims of the better ERAS and comfortable medicine.
Abstract:Health care quality is defined as a level of value provided by many health care resources, as determined by some measures.China has published quality measures for six specialties including anesthesiology, which are composed of structural measures, process measures, and outcome measures.Medical errors or adverse events can be caused by many factors such as human errors.Adverse events reporting and surgical checklists are the essential elements to avoid system risks.Quality management tools, such as root cause analysis, six sigma, and plan-do-check-action(PDCA), can further improve the medical quality, and are worthy of application to medical staffs.