Résumé
Continuous quality improvement is the essence and core of modern hospital quality management.Our hospital attaches great importance to quality management and constantly improves the system of management and takes charge of implementation of implement.Continuous quality improvement is based on actual condition in order to stimulate the staff′s enthusiasm, initiative and form the hospital culture of participating in quality management jointly.It can improve the overall quality of the hospital management in the process of the implementation of continuous quality improvement by finding and analyzing problems, actively implementing, and strengthening staffs′ consciousness of quality gradually.
Résumé
Objective To evaluate the safety and effect of laryngeal mask airway (LMA) general anesthesia in neonatal laparoscopic pyloromyotomy. Methods The clinical data of 100 neonates who had underwent laparoscopic pyloromyotomy were retrospectively analyzed. The neonates were divided into LMA group (50 cases) and tracheal intubation group (50 cases) according to the anesthesia method. The heart rate and mean arterial pressure (MAP) were recorded at the time points of preanesthesia (T0), tracheal intubation (T1), 10 min after tracheal intubation (T2) and extubation (T3), and the extubation time, and consumption of sevoflurane and postoperative complications were also recorded. Results All the 2 groups had smooth intubation and LMA, and the operation was completed successfully under laparoscope. There was no conversion to laparotomy. In LMA group, there were no statistical difference in heart rate and MAP at all the time points (P>0.05). The heart rate and MAP at T1 and T3 in tracheal intubation group were significantly higher than those at T0, and there were statistical differences (P<0.05). The heart rate and MAP at T1 and T3 were significantly lower than those in tracheal intubation group, heart rate:(131.1 ± 11.0) times/min vs. (146.9 ± 13.7) times/min and (131.9 ± 9.8) times/min vs. (147.3 ± 14.6) times/min; MAP: (44.2 ± 5.5) mmHg (1 mmHg = 0.133 kPa) vs. (47.9 ± 8.4) mmHg and (45.1 ± 7.3) mmHg vs. (49.1 ± 9.4) mmHg, and there were statistical differences (P<0.01 or<0.05). The extubation time, consumption of sevoflurane and incidences of postoperative complications in LMA group were significantly lower than those in tracheal intubation group:(6.1 ± 2.2) min vs. (12.5 ± 3.6) min, (2.9 ± 1.1) ml vs. (5.1 ± 1.9) ml and 4％ (2/50) vs. 48％ (24/50), and there were statistical differences (P<0.01). Conclusions LMA anesthesia in neonatal laparoscopic surgery is activated to maintain the steadiness of hemodynamics, which has less stress, anesthetic drugs consumption and respiratory complications compared with tracheal intubation .