增加尾部区块的利用,以促进NICU人群中的阿片类药物管理:一个质量改善项目
Fari Fall1, Devon Pace1, Kesavan Sadacharam2
1Department of Surgery, Nemours Children's Health, Wilmington, DE, USA; Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Journal of pediatric surgery
|October 2, 2024
概括
在新生儿中增加尾部阻塞的使用减少了阿片类药物需求,并改善了输出管率. 这种区域麻醉策略增强了新生儿重症监护室 (NICU) 的手术恢复和疼痛管理.
科学领域:
- 麻醉学 麻醉学
- 新生儿护理 新生儿护理
- 疼痛管理 疼痛管理
背景情况:
- 区域麻醉技术对于减轻疼痛和减少阿片类药物需求是有效的.
- 在新生儿重症监护室 (NICU) 患者中,区域麻醉,特别是尾部阻塞的使用不足.
- 实施了阿片类药物管理途径,在18个月内将尾巴块使用量从50%提高到90%.
研究的目的:
- 评估阿片类药物管理途径对新生儿尾巴块利用的影响.
- 评估手术内阿片类药物利用率和术后输出率的变化.
- 作为平衡措施,监测未缓解的疼痛和再输管率.
主要方法:
- 控制图表追踪了手术内阿片类药物使用 (MME/kg) 和术后输出率.
- 平衡措施包括未缓解的疼痛 (NPASS分数>/= 4),术后使用阿片类药物和24小时的再输管.
- 统计分析比较了带有尾巴块和没有尾巴块的手术之间的结果.
主要成果:
- 在干预后,尾尾块的利用率增加到63%.
- 术内阿片类药物利用率下降 (0.230 vs 0.416 MME/kg),而输出管的使用率增加 (75% vs 70%).
- 尾部阻塞与手术内阿片类药物使用显著减少 (p < 0.001) 和输出率增加 (p < 0.001) 相关,疼痛或术后阿片类药物使用没有增加.
结论:
- 尾巴块利用率的适度增加有效地减少了新生儿的手术内阿片类药物需求.
- 这种干预导致了手术后出率的改善,而不会影响疼痛控制.
- 尾部阻塞是对NICU患者阿片类药物管理的宝贵工具.
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