蒋勍 管婷 许小燕

[摘要] 目的 探讨麻醉复苏室（PACU）“麻护一体化管理联合预见性护理”模式对老年患者术后复苏的影响。 方法 选取2019年1～10月在我院接受手术的100例老年患者作为研究对象，随机分为研究组和对照组各50例。对照组采取常规护理方案，研究组在常规护理基础上结合麻醉护理一体化联合预见性护理方案。比较两组患者Steward评分、苏醒时间、苏醒期躁动发生率、并发症发生率、NRS疼痛评分、麻醉恢复评分（PARS）、护理满意度、平均交接时间、护理差错发生事件及入室与出室各项生命指征评分。 结果 研究组Steward评分显著高于对照组（P<0.01）、苏醒时间显著低于对照组（P<0.01），苏醒期躁动与并发症发生率均低于对照组（P<0.05）;研究组NRS疼痛評分显著低于对照组（P<0.01），PARS各项评分（肌力、呼吸、血压、神志、动脉血氧饱和度）及总分均显著高于对照组（P<0.01）;研究组平均交接时间、护理差错事件均显著少于对照组（P<0.01），护理满意度显著高于对照组（P<0.01）;研究组出室血压、呼吸、活动力及总分均显著高于对照组（P<0.01）。 结论 麻护一体化管理联合预见性护理可显著改善老年手术患者麻醉苏醒指标和疼痛状态，帮助联合护理模式顺利进行，提升护理满意度，提高PARS评分和手术患者出室生命指征评分。

[关键词] 麻醉护理一体化;预见性护理;并发症;Steward评分;PARS评分

[中图分类号] R614.2;R473          [文献标识码] B          [文章编号] 1673-9701（2020）17-0174-05

Study on the effect of "integrated anaesthesia and nursing management combined with predictive nursing" model in anesthesia resuscitation room on postoperative resuscitation of elderly patients

JIANG Qing   GUAN Ting   XU Xiaoyan

Department of Anesthesiology， Tongde Hospital of Zhejiang Province， Hangzhou   310012， China

[Abstract] Objective To investigate the effect of the integrated anesthesia and nursing management combined with predictive care model of postanesthesia Care Unit （PACU） on postoperative resuscitation in elderly patients. Methods A total of 100 elderly patients who underwent surgery in our hospital from January to October 2019 were selected as the research objects and randomly divided into study group and control group， with 50 cases in each group. The control group adopted the routine nursing program， and the study group was given the integrated anesthesia nursing combined with the predictive nursing program based on the routine nursing. The Steward score， wake-up time， the incidence of agitation in the wake-up period， complication rate， NRS pain evaluation， postanesthesia recovery score （PARS）， nursing satisfaction， average handover time， occurrence of nursing errors， and vital signs scores when entering and leaving anesthesia resuscitation room were compared between the two groups. Results The Steward score of the study group was significantly higher than that of the control group（P<0.01）， and the wake-up time of the study group was significantly lower than that of the control group（P<0.01）. The incidence of agitation and complications of the study group during the wake-up period were significantly lower than those of the control group（P<0.05）. The NRS pain score in the study group was significantly lower than that in the control group（P<0.01）. The PARS score of each term（muscle strength， respiration， blood pressure， consciousness， and arterial oxygen saturation） and the total score in the study group were significantly higher than those in the control group（P<0.01）. The average handover time and nursing error events in the study group were significantly less than those in the control group（P<0.01）， and the nursing satisfaction in the study group was significantly higher than that in the control group（P<0.01）. The blood pressure（P<0.01）， breathin（P <0.01）， mobility（P<0.01）， and total score（P<0.01） in the study group were significantly higher than those in the control group when leaving the resuscitation room. Conclusion Anesthesia and nursing integrated management combined with predictive nursing can significantly improve the anesthesia recovery index and pain state of elderly surgical patients， help the smooth implementation of the combined nursing model， improve nursing satisfaction， and improve the PARS score and the vital sign score of patients leaving the resuscitation room.

[Key words] Integrated anesthesia and nursing; Predictive nursing; Complications; Steward score; PARS score

随着医学技术的迅速发展与医学模式的转变，针对患者的护理工作已经逐渐由关注术后阶段扩展至关注患者手术结束至苏醒这一时间段。老年患者由于自身机体功能衰弱，代谢减缓，更易发生气道阻塞、呕吐及循环功能不稳定等并发症。因此麻醉复苏室（Postanesthesia care unit，PACU）作为麻醉手术患者的苏醒医疗单元，对老年患者术后的護理工作提出了更高更严的要求。临床研究表明，麻醉护理一体化管理能显著减少术后并发症，缩短患者的复苏时间[1-2]，且能降低患者心理焦虑积分，提高护理满意度[3]。预见性护理也称预前或超前护理，是在对患者病情进行全面综合分析判断后，提前预知护理问题，确定护理重点，以采取及时有效的护理预防性措施[4]。研究表明，预见性护理可降低并发症发生率并提高护理满意度[5-6]。……