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对接受心房或心室隔膜缺陷修复的儿童进行术前评估和规划的评估变化

Catherine C Dawson-Gore^1,2, Andrew Well^1,3,4, Scott Wallace⁴

¹Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA.

Cardiology in the young

|June 13, 2023

概括

在接受先天性心脏缺陷 (CHD) 修复的儿童的手术前护理中存在显著的差异. 评估心房隔膜缺陷 (ASD) 和心室隔膜缺陷 (VSD) 的这种变化可能会影响患者的治疗结果和医疗费用.

科学领域:

儿童心脏病学儿童心脏病学
生产性心脏手术手术生产心脏手术
医疗保健过程改进

背景情况:

遗传性心脏缺陷 (CHD) 护理是资源密集型的,不合理的变化可能会增加成本并对健康结果产生负面影响.
本研究研究了儿科心房隔膜缺陷 (ASD) 和心室隔膜缺陷 (VSD) 手术修复的手术前评估和规划的过程变化.
假设在这个手术前的过程中存在显著的变化,特别是在关键的护理点.

研究的目的:

识别和描述小儿ASD和VSD手术修复的手术前评估和规划过程中的变化.
评估手术前路径中的特定点的变化程度.
为未来研究这些变化对结果和成本的影响奠定基础.

主要方法:

基于对综合先天性心脏中心工作人员的采访,构建了一个初始过程地图.
在2018年7月至2020年11月期间,对32名患者进行了孤立的外科ASD或VSD修复.
评估了经过修订的流程地图,以确定一致性和可变性的点.

主要成果:

10名患者 (31%) 接受了手术评估前的干预心脏病学审查,原因包括未能通过导管关闭 (60%) 或资格不合格 (40%).
虽然最初的采访表明手术重新安排是主要的变化,但图表审查表明手术前干预心脏病学审查是变化的更突出的来源.
大多数患者 (94%) 在病例会议上进行了审查,参加了手术诊所,并且在手术前没有入院.

结论:

在小儿ASD/VSD手术修复的手术前评估和计划中发现了显著的变异性.
这种过程的变化可能会导致之前记录的CHD手术结果和成本的变化.
未来的研究应该确定是否确定变化是合理的,并量化它们对健康结果和成本的影响.

关键词:

生产性心脏手术是一种先天性心脏手术.心房隔膜缺陷是心房隔膜缺陷.在手术前的护理.腹腔隔膜缺陷腹腔隔膜缺陷

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