School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia.
Intensive Care Unit, The Northern Hospital, Epping, Vic., Australia.
J Clin Nurs. 2018 Oct;27(19-20):3544-3553. doi: 10.1111/jocn.14611. Epub 2018 Aug 7.
To establish the frequency of clinical deterioration in the early postoperative period in patients who have undergone general or orthopaedic surgery.
Worldwide, clinical deterioration is a significant problem in acute care settings. Early recognition and response to clinical deterioration is one of the ten National Safety and Quality Health Service Standards in Australia. However, there is limited understanding of the frequency of clinical deterioration in surgical patients.
A point prevalence study was conducted from September-October 2014. The records of 100 consecutive in patients admitted for orthopaedic (n = 48) or general surgery (n = 52) to a health service in Melbourne, Australia, were audited. The frequency of clinical deterioration episodes was summarised using descriptive statistics.
Baseline characteristics of the two patient groups were equivalent except that orthopaedic patients were older than the general surgery patients (median age 71 [IQR 19] years vs. 62 [IQR 17] years). There were 17 medical emergency team calls and 23 calls for urgent clinical review in 28 patients. The main indications for emergency calls were hypotension (26%), fever (19%), hypoxia (15%), tachycardia (13%) and altered blood glucose level (11%). The majority of episodes were managed on the ward, and there were one ICU transfer and no cardiac arrest calls.
One in four patients experienced early postoperative clinical deterioration. Hypotension was the most common trigger for escalation of care highlighting a need to optimise fluid and haemodynamic management of postoperative patients.
Haemodynamic instability leading to the activation of rapid response systems is very common in the immediate postoperative period. There is the need for locally tailored interventions to optimise fluid management and decrease incidence of further complications.
确定接受普通或骨科手术后患者在术后早期发生临床恶化的频率。
在全球范围内，临床恶化是急性护理环境中的一个重大问题。早期识别和对临床恶化的反应是澳大利亚十大国家安全和质量卫生服务标准之一。然而，对于手术患者临床恶化的频率了解有限。
进行了一项 2014 年 9 月至 10 月的时点患病率研究。对澳大利亚墨尔本一家医疗服务机构收治的 100 例连续骨科（n=48）或普外科（n=52）患者的记录进行了审核。使用描述性统计方法总结临床恶化事件的频率。
两组患者的基线特征相当，只是骨科患者比普外科患者年龄更大（中位数 71 [IQR 19] 岁比 62 [IQR 17] 岁）。28 名患者中有 17 次医疗急救队呼叫和 23 次紧急临床复查呼叫。紧急呼叫的主要指征是低血压（26%）、发热（19%）、低氧血症（15%）、心动过速（13%）和血糖水平改变（11%）。大多数事件在病房得到处理，有 1 例转入 ICU，无心脏骤停呼叫。
四分之一的患者经历了术后早期临床恶化。低血压是引发护理升级的最常见诱因，突出了优化术后患者液体和血液动力学管理的必要性。
术后即刻出现的血流动力学不稳定导致快速反应系统的激活非常常见。需要有针对性的当地干预措施来优化液体管理，减少进一步并发症的发生。
