Application of PDCA cycle combined with standardized operating procedures in reducing the incidence of perioperative hypothermia in urological endoscopic surgery

doi:10.3877/cma.j.issn.1674-3253.2025.05.009

Abstract

Abstract:

Objective

To explore the application effect of PDCA cycle combined with standardized operating procedures in reducing the incidence of perioperative hypothermia in patients undergoing urological endoscopic surgery.

Methods

From January to June 2023, 918 patients undergoing urological endoscopic surgery in Changhai Hospital, Navy Medical University were selected as the control group and received routine warming measures; from July to December 2023, 919 patients were selected as the observation group and received continuous quality improvement interventions using the PDCA cycle combined with standardized operating procedures. The incidence of intraoperative hypothermia, postoperative shivering, recovery period agitation, and body temperature changes during surgery were compared between the two groups.

Results

The incidence of intraoperative hypothermia, postoperative shivering, and recovery period agitation in the observation group was significantly lower than in the control group. Additionally, body temperatures at all monitoring time points were significantly higher in the observation group compared to the control group, with statistically significant differences (all P<0.05).

Conclusion

The implementation of PDCA cycle combined with standardized operating procedures effectively reduces the incidence of perioperative hypothermia in patients undergoing urological endoscopic surgery, reduces the risk of postoperative complications, shortens hospital stay, and improves patient satisfaction with nursing care.

Key words: Quality control, Perioperative hypothermia, Urological surgery, PDCA cycle, Standardized operating procedure

Yi Lu, Wei Zhang, Han Deng, Han Shi, Yu Feng, Xu Gao, Xiaofeng Wu. Application of PDCA cycle combined with standardized operating procedures in reducing the incidence of perioperative hypothermia in urological endoscopic surgery[J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(05): 598-604.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2025.05.009

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2025/V19/I05/598

Figures/Tables 3

References 36

[1]	von Ahlen C, Geissler A, Vogel J. Comparison of the effectiveness of open, laparoscopic, and robotic-assisted radical prostatectomies based on complication rates: a retrospective observational study with administrative data from Switzerland[J]. BMC Urol, 2024, 24(1): 215. DOI: 10.1186/s12894-024-01597-3.
[2]	Basunbul LI, Alhazmi LSS, Almughamisi SA, et al. Recent technical developments in the field of laparoscopic surgery: a literature review[J]. Cureus, 2022, 14(2): e22246. DOI: 10.7759/cureus.22246.
[3]	国家麻醉专业质量控制中心.围术期患者低体温防治专家共识(2023版)[J]. 协和医学杂志, 2023, 14(4): 734-743. DOI:10.12290/xhyxzz.2023-0266.
[4]	李玉梅. 泌尿外科内腔镜手术患者术中低体温风险因素分析及预测模型构建[D]. 兰州:兰州大学, 2021.
[5]	赵佳莲, 张小蝶, 吴昊. 新生儿非心脏手术术中低体温对预后的影响[J]. 中华医学杂志, 2024, 104(23): 2148-2153.DOI:10.3760/cma.j.cn112137-20231120-01139.
[6]	张震, 郭海云, 侯武刚, 等. 围手术期低体温研究进展[J]. 解放军医学杂志, 2023, 48(4): 476-481. DOI: 10.11855/j.issn.0577-7402.2023.04.0476.
[7]	Rogers AD, Saggaf M, Ziolkowski N. A quality improvement project incorporating preoperative warming to prevent perioperative hypothermia in major burns[J]. Burns, 2018, 44(5): 1279-1286. DOI: 10.1016/j.burns.2018.02.012.
[8]	Adams ES, Sobek DK 2nd, Eaves F. A cross-case comparison of hypothermia prevention methods and continuous improvement culture between aesthetic plastic surgery sites[J]. Aesthet Surg J, 2011, 31(1): 122-134. DOI: 10.1177/1090820X10391211.
[9]	王朝阳, 舒玲, 张刚, 等. 品管圈活动降低腔镜手术低体温发生率效果观察[J]. 齐鲁护理杂志, 2020, 26(14): 132-134. DOI: 10.3969/j.issn.1006-7256.2020.14.050.
[10]	Xu H, Wang Z, Guan X, et al. Safety of intraoperative hypothermia for patients: meta-analyses of randomized controlled trials and observational studies[J]. BMC Anesthesiol, 2020, 20(1): 202. DOI: 10.1186/s12871-020-01065-z.
[11]	孙凡皓, 于红, 殷波. 经尿道前列腺切除术患者发生术中低体温的危险因素[J]. 中国医科大学学报, 2022, 51(12): 1121-1125. DOI: 10.12007/j.issn.0258-4646.2022.12.012.
[12]	陶丽钦, 崔苏敏. 基于CiteSpace的围术期低体温研究热点的可视化分析[J]. 全科护理, 2023, 21(20):2766-2770. DOI: 10.12104/j.issn.1674-4748.2023.20.007.
[13]	李继平.护理管理学:2版[M].北京:人民卫生出版社,2006.
[14]	张卫贞.戴明环在呼吸系统重症病室医院感染管理中的应用效果[J]. 西藏医药, 2021, 42(5): 7-8.
[15]	谢素霞, 姜克文, 黄欣欣,等. RCA法联合戴明循环管理模式对住院患者抗菌药物治疗前病原学送检率的影响[J]. 中华医院感染学杂志, 2024, 34(2):272-276. DOI:10.11816/cn.ni.2024-231162.
[16]	段领燕, 周静, 肖静,等. PDCA循环在新组建多学科联合病区护理质量管理中的应用及效果评价 [J]. 当代护士(上旬刊), 2021, 28(11):184-186. DOI: 10.19791/j.cnki.1006-6411.2021.31.072.
[17]	马正良, 易杰. 围手术期患者低体温防治专家共识(2017)[J]. 协和医学杂志, 2017, 8(6): 352-358.
[18]	徐圣艳, 王哲敏, 倪丹利,等.基于ERAS理念下骨科手术患者护理模式的构建与临床实践[J]. 介入放射学杂志, 2024, 33(10): 2024, 33(10):后插5. DOI: 10.3969/j.issn.1008-794X.2024.10.027.
[19]	戴丹凤, 华钫静. 80/20法则在抢救车药品与物品管理中的应用[J]. 中医药管理杂志, 2019, 27(23): 76-77. DOI: 10.16690/j.cnki.1007-9203.2019.23.033.
[20]	Yi J, Zhan L, Lei Y, et al. Establishment and validation of a prediction equation to estimate risk of intraoperative hypothermia in patients receiving general anesthesia[J]. Sci Rep, 2017, 7(1): 13927. DOI: 10.1038/s41598-017-12997-x.
[21]	赵宏, 闫俊萍. 术中使用空气保温毯预防低体温效果的探讨[J]. 山西医药杂志, 2020, 49(1): 106-107. DOI: 10.3969/j.issn.0253-9926.2020.01.044.
[22]	Wesley Ely E, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS)[J]. JAMA, 2003, 289(22): 2983-2991. DOI: 10.1001/jama.289.22.2983.
[23]	徐婷, 张洁, 陆文博. 复合保温法在老年人工全髋关节置换术患者保温中的应用效果[J]. 中国老年学杂志, 2024, 44(13): 3169-3172.
[24]	刘艳丽, 张铭月. PDCA循环法在医院感染护理管理中的应用效果[J]. 中国社区医师, 2024, 40(24): 161-163.
[25]	Chalari E, Intas G, Zyga S, et al. Perioperative inadvertent hypothermia among urology patients who underwent transurethral resection with either TURis or transurethral resection of the prostate method[J]. Urologia, 2019, 86(2): 69-73. DOI: 10.1177/0391560318758937.
[26]	周肖. 泌尿外科腹腔镜手术患者围术期低体温与寒战的影响因素及标准化护理干预探讨[J]. 中国标准化, 2021(20): 205-207. DOI: 10.3969/j.issn.1002-5944.2021.20.054.
[27]	李玉梅, 张宏晨, 陈晓东, 等. 围术期低体温风险预测模型的研究进展[J]. 护理研究, 2021, 35(17): 3107-3110. DOI: 10.12102/j.issn.1009-6493.2021.17.018.
[28]	李欣欣, 田德龙, 李延海,等.全麻及椎管内麻醉恢复期患者发生低体温的危险因素[J]. 国际护理学杂志, 2022, 41(12):2161-2164. DOI:10.3760/cma.j.cn221370-20200815-00557.
[29]	罗雯春. 泌尿外科腹腔镜手术患者围术期低体温及寒战的影响因素与护理干预对策[J]. 青海医药杂志, 2020, 50(1): 32-34.
[30]	周羽. 基于证据的术中低体温护理质量敏感指标的构建[D].成都:成都医学院, 2023.
[31]	景亚柳, 李君, 宋润珞, 等. 手术室护理敏感质量指标构建研究的范围综述[J]. 全科护理, 2024, 22(1): 40-44.
[32]	卞伟峰, 辛玲, 伏瑜,等. 构建手术室护理质量敏感指标体系[J].中国卫生质量管理, 2020, 27(5):59-62+67. DOI:10.13912/j.cnki.chqm.2020.27.5.17.
[33]	Rauch S, Miller C, Bräuer A, et al. Perioperative hypothermia-a narrative review[J]. Int J Environ Res Public Health, 2021, 18(16): 8749. DOI: 10.3390/ijerph18168749.
[34]	李朝菊, 李平, 孙丽莉. PDCA循环管理在消毒供应中心护理管理中的应用[J]. 护理研究, 2024,38(3):522-525. DOI:10.12102/j.issn.1009-6493.2024.03.026.
[35]	景晨阳, 郭越, 樊落, 等. 急诊创伤患者低体温影响因素的Meta分析[J]. 中华急危重症护理杂志, 2024, 5(2): 131-137. DOI: 10.3761/j.issn.2096-7446.2024.02.007.
[36]	计燕, 柴菲, 周丽平, 等. 不同保温措施对腹部手术患者围术期低体温干预效果的网状Meta分析[J]. 现代临床护理, 2024, 23(8): 81-90. DOI: 10.3969/j.issn.1671-8283.2024.08.011.

项目	观察组（n=919）	对照组（n=918）	统计值	P值
性别[例(%)]			χ²=1.252	0.263
男	735 (79.98)	753 (82.03)
女	184 (20.02)	165 (17.97)
ASA分级[例(%)]			χ²=0.701	0.704
Ⅰ	65 (7.07)	72 (7.84)
Ⅱ	804 (87.49)	791 (86.15)
Ⅲ	50 (5.44)	55 (6.00)
手术方式[例(%)]			χ²=4.791	0.091
TURBt	221 (24.04)	182 (19.83)
TURP	313 (34.06)	332 (36.18)
fURL	385 (41.91)	404 (43.99)
术前合并症[例(%)]
高血压	374 (40.70)	385 (41.93)	χ²=0.292	0.589
糖尿病	128 (13.93)	110 (11.99)	χ²=1.542	0.214
年龄[岁，(±s)]	61.70±12.57	62.48±11.08	t=0.108	0.743
BMI[kg/m²，(±s)]	23.90±2.74	24.34±3.18	t=0.550	0.460
手术时间[min，(±s)]	69.56±30.91	68.42±29.15	t=0.036	0.850
麻醉时间[min，(±s)]	91.88±29.12	91.36±27.93	t=0.008	0.928

项目	观察组（n=919）	对照组（n=918）	统计值	P值
性别[例(%)]			χ²=1.252	0.263
男	735 (79.98)	753 (82.03)
女	184 (20.02)	165 (17.97)
ASA分级[例(%)]			χ²=0.701	0.704
Ⅰ	65 (7.07)	72 (7.84)
Ⅱ	804 (87.49)	791 (86.15)
Ⅲ	50 (5.44)	55 (6.00)
手术方式[例(%)]			χ²=4.791	0.091
TURBt	221 (24.04)	182 (19.83)
TURP	313 (34.06)	332 (36.18)
fURL	385 (41.91)	404 (43.99)
术前合并症[例(%)]
高血压	374 (40.70)	385 (41.93)	χ²=0.292	0.589
糖尿病	128 (13.93)	110 (11.99)	χ²=1.542	0.214
年龄[岁，(±s)]	61.70±12.57	62.48±11.08	t=0.108	0.743
BMI[kg/m²，(±s)]	23.90±2.74	24.34±3.18	t=0.550	0.460
手术时间[min，(±s)]	69.56±30.91	68.42±29.15	t=0.036	0.850
麻醉时间[min，(±s)]	91.88±29.12	91.36±27.93	t=0.008	0.928

组别	例数	围术期低体温	术后寒战	复苏期躁动
观察组	919	60 (6.53)	61 (6.64)	50 (5.44)
对照组	918	459 (50.00)	306 (33.33)	312 (33.99)
χ²值		428.14	204.72	236.52
P值		<0.001	<0.001	<0.001

组别	例数	围术期低体温	术后寒战	复苏期躁动
观察组	919	60 (6.53)	61 (6.64)	50 (5.44)
对照组	918	459 (50.00)	306 (33.33)	312 (33.99)
χ²值		428.14	204.72	236.52
P值		<0.001	<0.001	<0.001

组别	例数	术前体温	入手术室体温	麻醉30 min	麻醉60 min	麻醉90 min	手术结束	入PACU	出PACU
观察组	919	36.42±0.19	36.54±0.13	36.45±0.17	36.41±0.24	36.32±0.22	36.41±0.22	36.44±0.16	36.56±0.18
对照组	918	36.47±0.15	36.34±0.11	36.14±0.16	36.06±0.20	35.94±0.24	35.87±0.27	35.90±0.24	36.15±0.16
t值		0.572	27.084	34.742	24.886	27.560	49.914	37.434	54.286
P值		0.454	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

Please choose a citation manager

Content to export