Hilditch W G, Asbury A J, Crawford J M
University Department of Anaesthesia, Gartnavel General Hospital, 30 Shelley Court, Glasgow G12 OYN, UK.
Anaesthesia. 2003 Feb;58(2):117-24. doi: 10.1046/j.1365-2044.2003.02952.x.
Nurses assess patients pre-operatively using screening questionnaires and locally-developed protocols. Our objectives were to determine which questions might identify patients who should be seen by an anaesthetist before the day of surgery. A review of the literature and a preliminary questionnaire to establish questions to be tested was followed by a modified, two-round Delphi questionnaire to determine the level of agreement by anaesthetists. There was agreement for referring patients who gave a positive response to questions that query: restricted exercise tolerance; previous anaesthetic problems; family history of anaesthetic problem; pathology affecting neck movement; angina; arrhythmia; heart failure; asthma; epilepsy; insulin-dependent diabetes mellitus; liver disease and unspecified kidney disease. There was equivocal agreement on questions that report a myocardial infarction over one year ago, cerebrovascular accident, non insulin-dependent diabetes mellitus and thyroid disease. Nurses should use these criteria during pre-operative assessment to decide the timing of evaluation by an anaesthetist.
护士在术前使用筛查问卷和本地制定的方案对患者进行评估。我们的目标是确定哪些问题可以识别出那些在手术当天之前应由麻醉师诊视的患者。在对文献进行综述并设计一份初步问卷以确定待测试的问题之后，开展了一份经过修改的两轮德尔菲问卷，以确定麻醉师的共识程度。对于那些对以下问题给出肯定回答的患者需要转诊已达成共识：运动耐量受限；既往麻醉问题；麻醉问题家族史；影响颈部活动的病理学问题；心绞痛；心律失常；心力衰竭；哮喘；癫痫；胰岛素依赖型糖尿病；肝病和未明确的肾病。对于报告一年多前发生心肌梗死、脑血管意外、非胰岛素依赖型糖尿病和甲状腺疾病的问题，存在不明确的共识。护士在术前评估期间应使用这些标准来决定麻醉师进行评估的时机。
