目的

探讨失效模式与效应分析（FMEA）在达芬奇机器人辅助下食管裂孔疝修补手术护理配合中的应用。

方法

回顾性分析2021年4月至2023年12月在新疆维吾尔自治区人民医院行达芬奇机器人辅助下食管裂孔疝修补术患者的临床资料。将2021年4月至2022年7月的100例患者实施常规护理，为常规组；2022年8月至2023年12月的100例患者实施FMEA护理模式，为FMEA组。比较实施前后2组术中获得性压力性损伤（IAPI）防护措施实施不当、手术物品清点不规范、器械臂无菌套安装不规范、术中低体温预防措施执行不当、达芬奇机器人手术系统电外科设备操作不规范的风险优先指数（RPN）值，护理不良事件发生率（包括IAPI、手术物品清点数目不符、无菌屏障污染、术中低体温、术中电灼伤），医师对手术室护士的工作满意度。

结果

采取针对性的改进措施后，相应RPN值分别下降，差异有统计学意义（P＜0.05）；IAPI、手术物品清点数目不符、无菌屏障污染、术中低体温、术中电灼伤等护理不良事件的发生率均下降，差异有统计学意义（P＜0.05）；医师对手术护士满意度有所提高，差异有统计学意义（P＜0.05）。

结论

将失效模式与效应分析方法应用于达芬奇机器人辅助下食管裂孔疝修补手术护理配合中，效果良好，有效降低了不良事件的发生率，提高了手术护理质量及医师满意度，值得推广。

Objective

To explore the application effect of Failure Mode and Effects Analysis（FMEA） in nursing cooperation for esophageal hiatal hernia repair surgery assisted by da Vinci robots.

Methods

Retrospective analysis of clinical data of patients who underwent da Vinci robot assisted esophageal hiatal hernia repair surgery in our hospital from April 2021 to December 2023. A total of 100 patients from April 2021 to July 2022 were given routine care as the routine group， and 100 patients from August 2022 to December 2023 were given FMEA care as the FMEA group. Compare the risk priority number （RPN） values of two groups before and after implementation， including improper implementation of protective measures for intraoperative acquired pressure injuries， non-standard counting of surgical items，improper installation of sterile instrument arms， improper implementation of intraoperative hypothermia prevention measures， and improper operation of electrical surgical equipment in the da Vinci robotic surgical system， The incidence of nursing adverse events （including acquired pressure injuries， discrepancies in the number of surgical items counted， contamination of sterile barriers， intraoperative hypothermia， and intraoperative electric burns）， and the satisfaction of doctors with the work of operating room nurses.

Results

After taking targeted improvement measures， the corresponding RPN values decreased and the difference was statistically significant （P＜0.05）； The incidence of nursing adverse events such as IAPI，discrepancy in the number of surgical items counted， contamination of sterile barriers， intraoperative hypothermia， and intraoperative electric burns decreased significantly （P＜0.05）； The satisfaction of doctors with surgical nurses has improved， and the difference is statistically significant （P＜0.05）.

Conclusion

The application of failure mode and effect analysis method in the nursing coordination of esophageal hiatal hernia repair surgery assisted by da Vinci robot has shown good results， effectively reducing the incidence of adverse events， improving the quality of surgical care and doctor satisfaction， and is worthy of promotion.