外科医生需要照顾病情不佳的患者吗？医疗应急团队的作用。

Wong Kenneth, Levy Richard D

John Hunter Hospital, Newcastle, New South Wales, Australia.

ANZ J Surg. 2005 Oct;75(10):848-51. doi: 10.1111/j.1445-2197.2005.03480.x.

BACKGROUND

Medical emergency teams (MET) have been shown to reduce in-hospital morbidity and mortality of surgical patients. The present study reviews the experience with the use of MET in the care of critically unwell surgical patients.

METHODS

Data were prospectively collected on all patients in a general surgical unit of a tertiary referral centre meeting the criteria for activating a MET over a 6 month period. These data were retrospectively analysed with respect to surgical team and MET involvement in the care of these patients.

RESULTS

Over the 6 month study period, 22 patients qualified for a MET response based on criteria of physiological instability. A MET was activated for 13 of these patients (59%), with the remainder being managed by direct consultation with intensive care and medical staff. Forty-six per cent of MET activations were outside of normal working hours. Respiratory distress including tachypnoea and desaturation was the most commonly identified physiological abnormality (13 patients), accounting for 62% of MET activations. A MET was activated by a surgical registrar in 46% of cases. Seventy-seven per cent of MET activations were preceded by at least one registrar level assessment without resolution of the patient's clinical deterioration. The most common MET interventions were supplementation of oxygen therapy and initiation of pharmacotherapy (11 patients). The surgical team complemented the MET response by providing detailed information regarding the patient's surgical condition, premorbid status (13 patients), organized transfer to the operating theatre (three patients), initiated blood transfusions (two patients) and deciding to order abdominal computed tomography (two patients). Urgent surgical decision making was required in 23% of MET activations.

CONCLUSIONS

Medical emergency team activations for critically unwell surgical patients are complemented by surgical team involvement in the decision making and management process. The MET may be underutilized in the management of unwell surgical patients.

背景

医疗急救团队（MET）已被证明可降低外科手术患者的院内发病率和死亡率。本研究回顾了在救治病情危急的外科手术患者中使用MET的经验。

方法

前瞻性收集某三级转诊中心普通外科病房6个月内所有符合激活MET标准的患者的数据。对这些数据进行回顾性分析，以了解外科团队和MET在这些患者护理中的参与情况。

结果

在6个月的研究期间，22例患者因生理不稳定符合MET响应标准。其中13例患者（59%）激活了MET，其余患者通过直接咨询重症监护和医务人员进行管理。46%的MET激活发生在正常工作时间之外。呼吸窘迫，包括呼吸急促和血氧饱和度下降，是最常见的生理异常（13例患者），占MET激活的62%。46%的病例由外科住院医师激活MET。77%的MET激活之前至少有一次住院医师级别的评估，但患者的临床恶化情况未得到缓解。最常见的MET干预措施是补充氧疗和开始药物治疗（11例患者）。外科团队通过提供有关患者手术情况、病前状态的详细信息（13例患者）、安排转至手术室（3例患者）、开始输血（2例患者）以及决定进行腹部计算机断层扫描（2例患者）来辅助MET响应。23%的MET激活需要紧急手术决策。