通过实施定制指导方针,预防儿童的外科手术期间低温症
Shu Ying Lee1, Rehena Sultana2, John Carson Allen2
1Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore.
Singapore medical journal
|March 13, 2024
概括
定制指南在儿科手术患者中显著降低了术后低温 (PH). 然而,当连续核心温度监测传感器对患者造成成本时,这些指南的有效性下降了.
科学领域:
- 儿科麻醉学 儿科麻醉学
- 患者安全 患者安全
- 临床指南开发 临床指南开发
背景情况:
- 周围手术性低温 (PH) 是儿科手术中普遍存在的并发症,与不良结果有关.
- 现有的PH预防指南主要针对成年人,并表现出机构的变化.
- 需要评估为儿科患者量身定制的指南的有效性.
研究的目的:
- 评估定制指南在儿童手术患者降低PH的有效性.
- 分析成本考虑因素对医生遵守温度管理实践的影响.
- 评估持续核心温度监测传感器对PH发生率的影响.
主要方法:
- 一项前性队列研究,涉及3917名接受全身麻醉的儿科患者 (≤16岁).
- 在四个阶段收集数据:标准管理 (阶段1-2) 和指导方针实施 (阶段3-4).
- 连续核心温度监测传感器在第一和第三阶段免费提供,在第二和第四阶段收费. PH定义为核心温度<36°C.
主要成果:
- 指南的实施使PH发病率从11.0%降至6.79% (OR为0.63,P=0.0002).
- 自由传感器增加了PH的检测 (OR1.48,P=0.001).
- 与充电传感器 (OR 0.75) 相比,随着指导方针 (OR 0.64) 的自由传感器,PH的降低更为明显.
结论:
- 定制指南有效地减少了小儿外科手术患者的外科手术期间低温症.
- 指南对降低PH的积极影响被与监控传感器相关的成本相关因素所削弱.
- 实施具有成本效益的策略对于最大限度地利用儿科护理临床指南的好处至关重要.
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