Wacker Johannes, Staender Sven
aInstitute of Anesthesia and Intensive Care, Hirslanden Clinic, Zurich bDepartment of Anesthesia and Intensive Care Medicine, Regional Hospital Maennedorf, Maennedorf, Switzerland cDepartment of Anesthesiology, Perioperative Medicine, and Critical Care Medicine, Paracelsus Medical University, Salzburg, Austria.
Curr Opin Anaesthesiol. 2014 Dec;27(6):649-56. doi: 10.1097/ACO.0000000000000124.
Despite the benefits of rapidly advancing therapeutic and diagnostic possibilities, the perioperative setting still exposes patients to significant risks of adverse events and harm. Anesthesiologists are in midstream of perioperative care and can make significant contributions to patient safety and patient outcomes. This article reviews recent research results outlining the current trends of perioperative patient harm and summarizes the evidence in favor of patient safety practices.
Adverse events and patient harm continue to be frequent in the perioperative period. Adverse events occur in about 30% of hospital admissions, are associated with higher mortality, and may be preventable in more than 50%. Evidence-based recommendations are available for many patient safety issues. No magic bullet practices exist, but promising targets include the prevention and limitation of perioperative infections and of complications of airway and respiratory management, the maintenance of achieved safety standards, the use of checklists, and others.
Current research provides growing evidence for the effectiveness of several patient safety practices designed to prevent or diminish perioperative adverse events and patient harm. Future investigations will hopefully fill the numerous persisting knowledge gaps.
尽管快速发展的治疗和诊断手段带来了诸多益处,但围手术期仍使患者面临发生不良事件和伤害的重大风险。麻醉医生处于围手术期护理的核心环节,可为患者安全和治疗结果做出重大贡献。本文回顾了近期研究结果,概述了围手术期患者伤害的当前趋势,并总结了支持患者安全实践的证据。
围手术期不良事件和患者伤害仍然频发。约30%的住院患者会发生不良事件,不良事件与更高的死亡率相关,且超过50%的不良事件可能是可预防的。针对许多患者安全问题都有基于证据的建议。不存在万灵药式的做法,但有前景的目标包括预防和限制围手术期感染以及气道和呼吸管理的并发症、维持已达成的安全标准、使用检查表等。
当前研究为若干旨在预防或减少围手术期不良事件和患者伤害的患者安全实践的有效性提供了越来越多的证据。未来的研究有望填补众多持续存在的知识空白。