根本原因分析法在提升阴道分娩产妇椎管内麻醉使用率的应用效果OA
Application effect of root cause analysis in improving the utilization rate of intrathecal anesthesia for parturients undergoing vaginal delivery
目的 探讨根本原因分析法(RCA)在提升阴道分娩产妇椎管内麻醉使用率中的应用效果.方法 纳入2023-2025 年在石河子大学第一附属医院实施椎管内分娩镇痛的产妇1100例,按照年份分组,分析各组阴道分娩产妇椎管内麻醉使用率的差异,应用RCA法寻找阴道分娩产妇未进行椎管内麻醉的近端原因,通过5Why 法确定根本原因,进而制定改进策略,最终实施系统性策略,并进行长期监测,分别于2024、2025年末评价持续性改进的结果.结果 通过改进,阴道分娩产妇椎管内麻醉使用率 2024年较2023年提升15.0％,2025年较2024年提升7.4％;椎管内分娩镇痛产妇中,初产妇的占比2025年较2024年下降25.8％,高龄产妇的占比2025年较2024年上升 7.0％;阴道分娩产妇会阴侧切率2024年较2023年降低16.8％,2025年较2024年降低 5.5％,差异均有统计学意义(P<0.05).结论 与国内同类研究相比,本研究通过 RCA 设计出精细的整改措施,为提升阴道分娩产妇椎管内麻醉使用率,提供了系统的、有效的、科学的途径,填补了兵团地区椎管内分娩镇痛管理的研究空白.
Objective To investigate the application effect of the root cause analysis(RCA)in improving the utilization rate of intrathecal anesthesia for parturients undergoing vaginal delivery.Methods A total of 1 100 parturients who underwent intrathecal anesthesia for labor pain at the First Affiliated Hospital of Shihezi University from 2023 to 2025 were enrolled and grouped by the year of admission to analyze the differences in the utilization rate of intrathecal anesthesia for parturients undergoing vaginal delivery.The RCA method was utilized to identify the proximal causes for the absence of intrathecal anesthesia in these parturients,and the 5-Why method was applied to determine the root cause.Subsequently,improvement strategies were formulated and implemented systematically,followed by long-term monitoring.The outcomes of continuous improvement were evaluated at the end of 2024 and 2025,respectively.Results Through the improvements,the utilization rate of intrathecal anesthesia for parturients undergoing vaginal delivery increased by 15.0％in 2024 compared with that in 2023,and increased by 7.4％ in 2025 compared with that in 2024.Among parturients undergoing epidural analgesia for vaginal delivery at our hospital,the proportion of primiparae decreased by 25.8％in 2025 compared to 2024,while the proportion of elderly parturients increased by 7.0％ in 2025 compared to 2024.The episiotomy rate among parturients delivering vaginally at our hospital decreased by 16.8％ in 2024 compared to 2023 and by 5.5％ in 2025 compared to 2024,all the differences were statistically significant(P<0.05).Conclusion Compared with similar domestic studies,this study used RCA to develop detailed corrective measures,providing a systematic,effective,and scientific approach to improve the utilization rate of epidural anesthesia use among women giving birth vaginally,thereby filling a research gap in the management of intraspinal analgesia during childbirth in the Xinjiang Production and Construction Corps region.
刘虎;翟晶雯;党雪;殷姜文;李燕
兵团麻醉质控中心,石河子大学第一附属医院手术麻醉科,新疆石河子 832003兵团麻醉质控中心,石河子大学第一附属医院手术麻醉科,新疆石河子 832003兵团麻醉质控中心,石河子大学第一附属医院手术麻醉科,新疆石河子 832003兵团麻醉质控中心,石河子大学第一附属医院手术麻醉科,新疆石河子 832003兵团麻醉质控中心,石河子大学第一附属医院手术麻醉科,新疆石河子 832003
根本原因分析法阴道分娩椎管内麻醉质量管理
root cause analysisvaginal deliveryintrathecal anesthesiaquality management
《麻醉安全与质控》 2026 (4)
315-319,5
新疆维吾尔自治区"天山英才医学领军人才计划"(TSYC202401A091)
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