产科围麻醉期护理单元标准调查。

Wilkins Karen K, Greenfield Mary Lou V H, Polley Linda S, Mhyre Jill M

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI 48109, USA.

Anesth Analg. 2009 Jun;108(6):1869-75. doi: 10.1213/ane.0b013e31819f6f98.

BACKGROUND

Although obstetric patients are generally healthy, population risk is increasing because of increases in maternal age, obesity, and rates of multifetal pregnancies, and complications may occur in the immediate postoperative period. In this study, we sought to identify the current level of recovery care for obstetric patients in North American academic institutions after either general or major neuraxial anesthesia for cesarean delivery.

METHODS

A survey of obstetric anesthesia recovery practices was delivered electronically to 135 obstetric anesthesiology directors of North American academic institutions from June to October, 2007. Surveys were completed electronically and anonymously.

RESULTS

The response rate was 54.8% (74 of 135). Respondents reported a median of 2550 deliveries per year (interquartile range [IQR] 2000, 4000), with 30% delivered by cesarean delivery (IQR 25.5%, 32.5%) and 5% of cesarean deliveries performed under general anesthesia (IQR 4%, 8%). Most institutions recovered postcesarean patients in either an obstetric perianesthesia care unit or a labor, delivery, and recovery room. Recovery care was staffed solely by perinatal nurses, rather than dedicated perianesthesia care unit nurses in most institutions. Forty-five percent (28 of 62) of institutions had no specific postanesthesia recovery training for nursing staff providing postcesarean care for patients recovering from neuraxial or general anesthesia. Forty-three percent (29 of 67) of respondents rated the recovery care provided to cesarean delivery patients as lower quality than care given to general surgical patients. Respondents who relied solely on perinatal nurses to provide postanesthesia care were most likely to perceive that postanesthetic care for cesarean delivery was of lower quality than that given to general surgery patients (P = 0.008).

CONCLUSIONS

Guidelines put forth by the American Society of Anesthesiologists Task Force on Postanesthetic Care and the American Society of PeriAnesthesia Nurses apply to all postoperative patients regardless of their recovery locations. Results from this survey suggest that the level of care provided for postanesthesia recovery from cesarean delivery in North American academic institutions may not meet these guidelines.

背景

尽管产科患者一般较为健康，但由于产妇年龄增加、肥胖以及多胎妊娠率上升，总体风险在增加，且术后即刻可能出现并发症。在本研究中，我们试图确定北美学术机构中接受剖宫产全身麻醉或主要椎管内麻醉的产科患者当前的恢复护理水平。

方法

2007年6月至10月，对北美学术机构的135名产科麻醉科主任进行了关于产科麻醉恢复实践的电子问卷调查。调查问卷通过电子方式完成且为匿名形式。

结果

回复率为54.8%（135名中的74名）。受访者报告每年剖宫产分娩的中位数为2550例（四分位间距[IQR]为2000，4000），其中30%为剖宫产分娩（IQR为25.5%，32.5%），5%的剖宫产在全身麻醉下进行（IQR为4%，8%）。大多数机构在产科围麻醉护理单元或分娩、接生及恢复室对剖宫产术后患者进行恢复护理。在大多数机构中，恢复护理仅由围产期护士提供，而非专门的围麻醉护理单元护士。45%（62家机构中的28家）的机构没有为为接受椎管内或全身麻醉后恢复的剖宫产患者提供护理的护理人员进行专门的麻醉后恢复培训。43%（67名受访者中的29名）的受访者认为为剖宫产患者提供的恢复护理质量低于为普通外科患者提供的护理。完全依赖围产期护士提供麻醉后护理的受访者最有可能认为剖宫产的麻醉后护理质量低于普通外科患者（P = 0.008）。