术前代码状态管理的挑战:在瑞士麻醉师中进行的国家调查
Samuel K Zumbrunn1, Flavio Gössi1,2, Benjamin Bissmann1
1Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
Resuscitation plus
|December 25, 2025
概括
大多数麻醉科医生讨论中等风险手术患者的代码状态,但缺乏正式培训. 经验增加和CPR暴露与更频繁的讨论相关,强调需要更好的教育和指导方针.
科学领域:
- 麻醉学 麻醉学
- 医学伦理 医学伦理
- 手术患者护理手术患者护理
背景情况:
- 术后代码状态讨论对于以患者为中心的护理至关重要.
- 麻醉科医生关于这些讨论的现行做法有很大的不同.
- 在外科手术期间,经常缺乏管理"不复苏" (DNR) 命令的标准化方法.
研究的目的:
- 评估麻醉科医生的当前实践和信仰,关于外科手术期间的代码状态讨论.
- 确定影响手术患者代码状态讨论频率的因素.
- 为了评估在外科手术期间的DNR命令患者的管理.
主要方法:
- 在瑞士的麻醉科医生中进行了一项全国性的基于网络的调查.
- 该调查评估了不同美国麻醉学会 (ASA) 身体状况分类 (ASA 1-5) 中代码状态讨论的频率.
- 收集了关于术后重症监护室 (ICU) 入院,并发症,治疗限制和DNR订单管理的数据.
主要成果:
- 56.8%的麻醉师经常与中等风险患者讨论代码状态 (ASA 3-4).
- 更大的经验,更高的心肺复苏 (CPR) 暴露,以及对机构教学的认识与更频繁的讨论有关.
- 76.3%的人与DNR患者讨论了代码状态,70.4%的人支持在术前遵守DNR命令.
结论:
- 对于中等风险患者来说,代码状态讨论是常见的,但正式培训有限.
- 麻醉师的经验和临床暴露对代码状态讨论实践产生了积极的影响.
- 显然需要加强培训和标准化指导方针,以实现一致的伦理经营期间代码状态管理.
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