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夜间手术患者死亡率是白天2倍?

2016-09-07 岚逸筠篁 医学界

几乎每个外科医师和手术室护士都有晚上在手术室奋战的经历,界哥以前轮转时也经历过从早上七点半到晚上十一点半站在手术台边,除了吃饭和上两次厕所,根本没歇过。可以说,夜间手术就是家常便饭,甚至一些择期手术就是选在晚上实施。然而,在八月底召开的世界麻醉学大会上,加拿大的一项研究显示,夜间手术的患者死亡率是白天手术的两倍!难道手术时间真和患者死亡率有关?夜间真有死神降临?研究团队在2010年4月至2015年

几乎每个外科医师和手术室护士都有晚上在手术室奋战的经历,界哥以前轮转时也经历过从早上七点半到晚上十一点半站在手术台边,除了吃饭和上两次厕所,根本没歇过。可以说,夜间手术就是家常便饭,甚至一些择期手术就是选在晚上实施。

然而,在八月底召开的世界麻醉学大会上,加拿大的一项研究显示,夜间手术的患者死亡率是白天手术的两倍!难道手术时间真和患者死亡率有关?

夜间真有死神降临?

研究团队在2010年4月至2015年3月对加拿大蒙特利尔一家医院共超过7.5万的急诊和择期手术患者,根据三个时间段(白天7:30~15:29;下午和晚间15:30~23:29;夜间23:30~次日7:29)进行统计。

对患者总体健康状况和其他因素进行评估后,发现夜间手术患者的死亡风险,比白天手术患者高2.17倍,下午和晚间的手术患者比白天的高1.43倍。为何出现这样的差别,论文作者认为可能和夜间医务人员疲劳,夜间人手短缺或治疗延迟有关。

但小编认为影响患者死亡风险的因素有很多,以此说明手术时间对患者死亡风险的影响似乎并不靠谱。而论文仅仅在会议上发表,暂未在同行评议期刊上刊发,因此界哥认为需要等论文正式刊发后才能判断研究结论的质量。

周末手术患者死亡风险也高?

在去年《英国医学杂志质量与安全》(BMJ Qual Saf)上有一项研究和刚刚我们说的类似,也是研究手术时间对死亡风险的影响,结果得出的结论竟然是周末手术患者死亡风险高于工作日的手术患者。

英国研究团队在2008~2011四年间对163家英国公立医院的近400万择期手术患者进行跟踪调查,研究其手术时间、主刀顾问医生资历对30天死亡率的影响。结果发现,手术患者30天死亡率和主刀医生的资历关系不大,但和是否在周末手术有关:
 

虽然数据上说主刀医生资历和患者死亡率有关,但是进一步统计发现周末医师组成上有差异,因此研究者认为这并不能支持主刀医生资历和患者死亡率有关的结论。

研究通讯作者Paul Aylin认为,这和所谓的“周末效应”有关,而“周末效应”可能和周末医院的医护人员及相应服务减少密切相关。而近几年来,日本、澳大利亚、德国等国家的研究也证实了这一观点。

有学者指出,这些研究都表明我们无法在整个一周内一直达到优质的护理水平,仅仅依靠在工作日的良好服务还不够,为提供连续且安全的全天候服务开展更多工作,这样不管哪天接受手术,患者都可以获得同样的专业与优质护理。

但是小编认为,晚间夜间手术患者死亡率比其他时段手术患者死亡率高也是和医疗服务质量的下降有关。在晚间和夜间时段,医务人员的数量明显不如白天,也可能与工作状态松懈、急诊危重手术居多等原因有关。因此我们不能说这是“时间玄学”的因素,而是应该关注医疗服务质量的提高和缺陷上。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1983485, encodeId=96591983485dd, content=<a href='/topic/show?id=628553048e3' target=_blank style='color:#2F92EE;'>#患者死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53048, encryptionId=628553048e3, topicName=患者死亡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat Feb 25 16:37:00 CST 2017, time=2017-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113180, encodeId=5ade113180ec, content=个人觉得影响不大!, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:58:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113181, encodeId=f6fc11318172, content=晚间夜间手术患者死亡率比其他时段手术患者死亡率高也是和医疗服务质量的下降有关~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:58:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113178, encodeId=10101131e834, content=夜间真有死神降临?~~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113179, encodeId=14711131e9cf, content=可能和夜间医务人员疲劳,夜间人手短缺或治疗延迟有关!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112950, encodeId=680d112950e1, content=手术医生,麻醉医师的疲劳程度和注意力集中程度直接影响患者的死亡率!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zqSSMhCvIZtq4uqLEqQzEDcV8Vwet8S506muYbEDWicWNq968mO5jSibaVVDeMf5067MnZ4XgE6clw/0, createdBy=7feb1930691, createdName=针尖跳舞, createdTime=Wed Sep 07 09:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=)]
    2016-09-07 1e0d99ddm02(暂无匿称)

    个人觉得影响不大!

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1983485, encodeId=96591983485dd, content=<a href='/topic/show?id=628553048e3' target=_blank style='color:#2F92EE;'>#患者死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53048, encryptionId=628553048e3, topicName=患者死亡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat Feb 25 16:37:00 CST 2017, time=2017-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113180, encodeId=5ade113180ec, content=个人觉得影响不大!, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:58:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113181, encodeId=f6fc11318172, content=晚间夜间手术患者死亡率比其他时段手术患者死亡率高也是和医疗服务质量的下降有关~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:58:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113178, encodeId=10101131e834, content=夜间真有死神降临?~~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113179, encodeId=14711131e9cf, content=可能和夜间医务人员疲劳,夜间人手短缺或治疗延迟有关!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112950, encodeId=680d112950e1, content=手术医生,麻醉医师的疲劳程度和注意力集中程度直接影响患者的死亡率!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zqSSMhCvIZtq4uqLEqQzEDcV8Vwet8S506muYbEDWicWNq968mO5jSibaVVDeMf5067MnZ4XgE6clw/0, createdBy=7feb1930691, createdName=针尖跳舞, createdTime=Wed Sep 07 09:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=)]
    2016-09-07 1e0d99ddm02(暂无匿称)

    晚间夜间手术患者死亡率比其他时段手术患者死亡率高也是和医疗服务质量的下降有关~~

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1983485, encodeId=96591983485dd, content=<a href='/topic/show?id=628553048e3' target=_blank style='color:#2F92EE;'>#患者死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53048, encryptionId=628553048e3, topicName=患者死亡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat Feb 25 16:37:00 CST 2017, time=2017-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113180, encodeId=5ade113180ec, content=个人觉得影响不大!, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:58:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113181, encodeId=f6fc11318172, content=晚间夜间手术患者死亡率比其他时段手术患者死亡率高也是和医疗服务质量的下降有关~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:58:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113178, encodeId=10101131e834, content=夜间真有死神降临?~~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113179, encodeId=14711131e9cf, content=可能和夜间医务人员疲劳,夜间人手短缺或治疗延迟有关!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112950, encodeId=680d112950e1, content=手术医生,麻醉医师的疲劳程度和注意力集中程度直接影响患者的死亡率!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zqSSMhCvIZtq4uqLEqQzEDcV8Vwet8S506muYbEDWicWNq968mO5jSibaVVDeMf5067MnZ4XgE6clw/0, createdBy=7feb1930691, createdName=针尖跳舞, createdTime=Wed Sep 07 09:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=)]
    2016-09-07 1e0d99ddm02(暂无匿称)

    夜间真有死神降临?~~~

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1983485, encodeId=96591983485dd, content=<a href='/topic/show?id=628553048e3' target=_blank style='color:#2F92EE;'>#患者死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53048, encryptionId=628553048e3, topicName=患者死亡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat Feb 25 16:37:00 CST 2017, time=2017-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113180, encodeId=5ade113180ec, content=个人觉得影响不大!, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:58:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113181, encodeId=f6fc11318172, content=晚间夜间手术患者死亡率比其他时段手术患者死亡率高也是和医疗服务质量的下降有关~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:58:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113178, encodeId=10101131e834, content=夜间真有死神降临?~~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113179, encodeId=14711131e9cf, content=可能和夜间医务人员疲劳,夜间人手短缺或治疗延迟有关!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112950, encodeId=680d112950e1, content=手术医生,麻醉医师的疲劳程度和注意力集中程度直接影响患者的死亡率!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zqSSMhCvIZtq4uqLEqQzEDcV8Vwet8S506muYbEDWicWNq968mO5jSibaVVDeMf5067MnZ4XgE6clw/0, createdBy=7feb1930691, createdName=针尖跳舞, createdTime=Wed Sep 07 09:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=)]
    2016-09-07 1e0d99ddm02(暂无匿称)

    可能和夜间医务人员疲劳,夜间人手短缺或治疗延迟有关!!

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1983485, encodeId=96591983485dd, content=<a href='/topic/show?id=628553048e3' target=_blank style='color:#2F92EE;'>#患者死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53048, encryptionId=628553048e3, topicName=患者死亡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=12de429, createdName=sunylz, createdTime=Sat Feb 25 16:37:00 CST 2017, time=2017-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113180, encodeId=5ade113180ec, content=个人觉得影响不大!, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:58:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113181, encodeId=f6fc11318172, content=晚间夜间手术患者死亡率比其他时段手术患者死亡率高也是和医疗服务质量的下降有关~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:58:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113178, encodeId=10101131e834, content=夜间真有死神降临?~~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113179, encodeId=14711131e9cf, content=可能和夜间医务人员疲劳,夜间人手短缺或治疗延迟有关!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Wed Sep 07 15:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112950, encodeId=680d112950e1, content=手术医生,麻醉医师的疲劳程度和注意力集中程度直接影响患者的死亡率!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zqSSMhCvIZtq4uqLEqQzEDcV8Vwet8S506muYbEDWicWNq968mO5jSibaVVDeMf5067MnZ4XgE6clw/0, createdBy=7feb1930691, createdName=针尖跳舞, createdTime=Wed Sep 07 09:57:00 CST 2016, time=2016-09-07, status=1, ipAttribution=)]
    2016-09-07 针尖跳舞

    手术医生,麻醉医师的疲劳程度和注意力集中程度直接影响患者的死亡率!

    0

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