以护理安全核查为核心的结构化术前访视对全麻患者手术时间的影响

The Impact of a Structured Preoperative Visit Centered on Nursing Safety Verification on the Operation Time of Patients under General Anesthesia

摘要: 目的：探讨以护理安全核查为核心的结构化术前访视对全麻患者手术时间的影响。方法：采用单中心非随机前后对照(时间分组)研究设计，回顾性选取2024年1月至2024年11月期间在珠海市中西医结合医院行择期全麻手术的86例患者作为研究对象。按干预实施时间分为对照组(常规术前访视，2024年1~4月，n = 43)和观察组(干预组，结构化术前访视，2024年7~11月，n = 43)。比较两组患者的一般资料、手术时间、术前准备时间、入室至切皮时间、麻醉时间及术中出血量。对偏态分布结局优先采用Mann-Whitney U检验，以多元线性回归作为校正混杂因素的探索性分析并检验模型假设，同时采用分位数回归进行敏感性分析，按手术科室进行亚组分析。结果：两组在BMI、性别、手术科室方面均衡可比(P > 0.05)；观察组年龄高于对照组(P = 0.034)，ASA分级分布差异有统计学意义(P = 0.019)，观察组ASA Ⅲ级患者比例较高(11.6% vs 0%)。未校正分析显示，观察组手术时间、麻醉时间、入室至切皮时间及术中出血量均高于对照组，差异有统计学意义(P < 0.05)；术前准备时间两组差异无统计学意义(P = 0.547)。多元线性回归校正年龄、ASA分级、性别及手术科室后，分组对各项手术时间指标均无统计学效应(P > 0.05)，分位数回归敏感性分析结论一致，提示未校正组间差异主要源于两组基线不均衡。亚组分析显示，不同科室组间差异方向不一致：普外科观察组手术时间、麻醉时间短于对照组，泌尿外科观察组手术时间、术前准备时间、麻醉时间及骨科观察组手术时间、入室至切皮时间长于对照组(P < 0.05)；因亚组样本量较小且未进行多重比较校正，仅作探索性解释。结论：在当前样本量与研究设计下，以护理安全核查为核心的结构化术前访视组未校正的手术时间、麻醉时间、入室至切皮时间及术中出血量高于常规访视组，但校正年龄、ASA分级等基线不均衡后组间差异不再显著，提示该差异更可能反映病例构成差异而非干预本身的效应。该模式并非替代两组共同执行的入室前核查、麻醉前核查和手术开始前三方核查，而是将核查要点前移并清单化；其对手术效率及安全结局的真实影响仍需前瞻性随机、大样本研究进一步验证。

Abstract: Objective: To explore the influence of structured preoperative visit with nursing safety verification as the core on the operation time of patients under general anesthesia. Methods: A single-center non-randomized before-and-after control (time grouping) study design was adopted, and 86 patients who underwent elective general anesthesia in Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from January 2024 to November 2024 were selected retrospectively as the research object. According to the time of intervention, they were divided into control group (routine preoperative visit, January-April, 2024, n = 43) and observation group (intervention group, structured preoperative visit, July-November, 2024, n = 43). The general data, operation time, preoperative preparation time, time from entering the room to skin incision, anesthesia time and intraoperative blood loss were compared between the two groups. Mann-Whitney U test is preferred for the outcome of skewed distribution, multiple linear regression is used as an exploratory analysis to correct confounding factors and test the model hypothesis, while quantile regression is used for sensitivity analysis, and subgroup analysis is carried out according to surgical departments. Results: The BMI, gender and operation department of the two groups were balanced and comparable (P > 0.05). The age of the observation group was higher than that of the control group (P = 0.034), and the distribution of ASA grades was statistically different (P = 0.019). The proportion of patients with ASA Ⅲ in the observation group was higher (11.6% vs 0%). Uncorrected analysis showed that the operation time, anesthesia time, time from entering the room to skin incision and intraoperative bleeding in the observation group were higher than those in the control group, with statistical significance (P < 0.05). There was no significant difference in preoperative preparation time between the two groups (P = 0.547). After adjusting for age, ASA grade, sex and operation department by multiple linear regression, there was no statistical effect on each operation time index (P > 0.05), and the results of quantile regression sensitivity analysis were consistent, suggesting that the difference between uncorrected groups was mainly due to the baseline imbalance between the two groups. Subgroup analysis showed that the direction of differences among different departments was different: the operation time and anesthesia time in the general surgery observation group were shorter than those in the control group, while the operation time, preoperative preparation time, and anesthesia time in the urology observation group, and the operation time and the time from entering the room to skin incision in the orthopedic observation group were longer than those in the control group (P < 0.05); because of the small sample size of the subgroup and the lack of multiple comparison and correction, it is only an exploratory explanation. Conclusion: Under the current sample size and research design, the uncorrected operation time, anesthesia time, time from entering the room to skin incision and intraoperative blood loss in the structured preoperative interview group with nursing safety verification as the core are higher than those in the routine interview group, but the difference between the two groups is no longer significant after correcting the baseline imbalance such as age and ASA grade, suggesting that the difference is more likely to reflect the difference in case composition than the effect of intervention itself. This model does not replace the three-party check-up before entering the room, before anesthesia and before the operation, but moves the key points forward and lists them. Its real impact on surgical efficiency and safe outcome still needs to be further verified by prospective randomized and large sample studies.