住院醫師與手術專責護理師擔任刀助對於全膝關節置換手術預後之比較

Comparisons between Resident Doctors and Operation Professional Nurses as Surgical Assistants in Total Knee Replacement Surgery

根據衛生福利部政策，近年來骨科住院醫師的年度訓練容額有所限縮。而隨著人口的高齡化，台灣退化性關節炎盛行率的增加，也導致全膝關節置換手術的需求增長。因此，目前作為人力缺口的補充，手術專責護理師擔任刀助，已顯得日益重要。然而，相較於目前已完善制定的專科護理師制度，刀助在侵入性治療的授權程度、職責以及訓練上仍欠缺明確規範。考量到病人安全與醫療品質，我們分析比較住院醫師與手術專責護理師擔任刀助，對於全膝關節置換手術預後之差異，結果顯示手術專責護理師並不遜於住院醫師，且甚至有更好的手術預後(更低的輸血單位)。因此可見，對於刀助的訓練和醫療行為授權，有必要擬定更明確之相關法規。

According to the police of Ministry of Health and Welfare, the annual training quota of resident doctors (RD) was reduced in recent years, and Orthopedic RD were included. However, as an aging society, the prevalence rate of osteoarthritis in Taiwan was increasing, which leads to the growing demand of total knee replacement (TKR). Thus, nowadays operation professional nurses (OPN) were gradually taking an important role as surgical assistants (SA) under the situation of short-staffed. Nevertheless, as relevant laws and regulations of nursing practitioner (NP) were established, there still lacked of specific legal and normative framework about the duty, medical auxiliary behavior, and training of SA. Regarding the issues about patient safety, health care quality, and legal ambiguity, we want to know whether there was prognostic difference between RD and OPN as SA in TKR. In our study, while OPN as SA, the outcomes of patient who received TKR was not inferior to RD, and even better (less blood transfusion units). Therefore, a much clearer regulation to manage the training and authorize the professional practices of SA will be necessary.