Webb R K, van der Walt J H, Runciman W B, Williamson J A, Cockings J, Russell W J, Helps S
Department of Anaesthesia and Intensive Care, University of Adelaide, S.A.
Anaesth Intensive Care. 1993 Oct;21(5):529-42. doi: 10.1177/0310057X9302100508.
The role of monitors in patients undergoing general anaesthesia was studied by analysing the first 2000 incidents reported to the Australian Incident Monitoring Study; 1256 (63%) were considered applicable to this study. In 52% of these a monitor detected the incident first; oximetry (27%) and capnography (24%) detected over half of the monitor detected incidents, the electrocardiograph 19%, blood pressure monitors 12%, a low pressure (circuit) alarm 8%, and the oxygen analyser 4%. Of the other monitors used, 5 first detected 1-2% of incidents, and the remaining 8 less than 0.5% each. The oximeter would have detected over 40% of the monitor detected incidents had its more informative modulated pulse tone always been relied upon instead of the "bleep" of the ECG. A theoretical analysis was then carried out to determine which of an array of 17 monitors would reliably have detected each incident had each monitor been used on its own and had the incident been allowed to evolve. To facilitate "scoring" of monitors, the incidents were categorized empirically into 60 clinical situations; 40% of applicable incidents were accounted for by only 5 clinical situations, 60% by 10 and nearly 80% by 20. 98% were accounted for by the 60 situations. A pulse oximeter, used on its own, would theoretically have detected 82% of applicable incidents (nearly 60% before any potential for organ damage). These figures for capnography are 55% and 43% and for oximetry and capnography combined are 88% and 65%, respectively. With the addition of blood pressure monitoring these become 93% and 65%, and of an oxygen analyser, 95 and 67%. Other monitors, including the ECG, each increase the yield by by less than 0.5%. The international monitoring recommendations and those of the Australian and New Zealand College of Anaesthetists are thoroughly vindicated by the patterns revealed in this study. The priority sequence of monitor acquisition for those with limited resources should be stethoscope, sphygmomanometer, oxygen analyser if nitrous oxide is to be used, pulse oximeter, capnograph, high pressure alarm, and, if patients are to be mechanically ventilated, a low pressure alarm (or spirometer with alarm); an ECG, a defibrillator, a spirometer and a thermometer should be available.
通过分析向澳大利亚事件监测研究报告的前2000起事件，研究了监测仪在全身麻醉患者中的作用；其中1256起（63%）被认为适用于本研究。在这些事件中，52%是监测仪首先检测到的；脉搏血氧饱和度仪（27%）和二氧化碳监测仪（24%）检测到了超过一半由监测仪发现的事件，心电图监测仪为19%，血压监测仪为12%，低压（回路）警报为8%，氧分析仪为4%。在使用的其他监测仪中，5种首先检测到1%-2%的事件，其余8种每种检测到的事件不到0.5%。如果一直依赖脉搏血氧饱和度仪更具信息量的调制脉冲音而非心电图的“哔哔”声，那么它将检测到超过40%由监测仪发现的事件。然后进行了一项理论分析，以确定如果单独使用17种监测仪中的每一种，并且让事件发展，哪种监测仪能够可靠地检测到每一起事件。为便于对监测仪进行“评分”，这些事件根据经验被分类为60种临床情况；40%的适用事件仅由5种临床情况构成，60%由10种构成，近80%由20种构成。98%的事件由这60种情况构成。理论上，单独使用脉搏血氧饱和度仪可检测到82%的适用事件（在出现任何器官损伤可能性之前接近60%）。二氧化碳监测仪的这些数字分别为55%和43%，脉搏血氧饱和度仪和二氧化碳监测仪联合使用时分别为88%和65%。加上血压监测后，这些数字变为93%和65%，再加上氧分析仪则为95%和67%。其他监测仪，包括心电图监测仪，每种使检测率提高不到0.5%。本研究揭示的模式充分证明了国际监测建议以及澳大利亚和新西兰麻醉师学院的建议是正确的。对于资源有限的人来说，购置监测仪的优先顺序应为听诊器、血压计，如果要使用氧化亚氮则为氧分析仪、脉搏血氧饱和度仪、二氧化碳监测仪、高压警报器，并且如果患者要进行机械通气，则为低压警报器（或带警报的肺活量计）；还应配备心电图监测仪、除颤器、肺活量计和温度计。
