持续质量改进降低腹膜透析中心腹膜透析相关性腹膜炎  

Continuous quality improvement decreased the rate of peritonitis in a peritoneal dialysis center

作　　者：杨渊 范为荣 沈娟娟 潘敏燕 陈帼英 陆勤勉 金炜 YANG Yuan;FAN Wei-rong;SHEN Juan-juan;PAN Min-yan;CHEN Guo-ying;LU Qin-mian;JIN Wei(Department of Nephrology,Tongxiang First People＇s Hospital,Zhejiang 314500,China)

机构地区：[1]桐乡市第一人民医院肾内科,桐乡314500

出　　处：《中国血液净化》2018年第11期727-730,共4页Chinese Journal of Blood Purification

摘　　要：目的通过持续质量改进(continuous quality improvement,CQI),降低腹膜透析(peritoneal dialysis,PD)患者腹膜透析相关性腹膜炎的发生率,分析腹膜炎的特征及结局。方法运用PDCA四步法,即设计(plan)—实施(do)—检验(check)—应用(act),设计并实施降低腹膜透析患者腹膜炎的流程。选择桐乡市第一人民医院肾内科腹膜透析中心未进行CQI的86例腹膜透析患者为对照组,选择进行CQI的102例腹膜透析患者为观察组,分析CQI前后腹膜透析患者腹膜炎的发生率、特征及结局。结果该中心腹膜透析相关性腹膜炎的发生率由CQI前的0.2093次/(患者·年)降至CQI后的0.0980次/(患者·年)(x^2=4.557,P=0.033);其中革兰氏阳性菌所致腹膜炎发生率由0.1395次/(患者·年)降至0.0490次/(患者·年)(x^2=4.424,P=0.035);PD更换腹膜透析液操作不规范所致腹膜炎发生率由0.1163次/(患者·年)降至0.0392次/(患者·年)(x^2=4.020,P=0.045)。结论通过持续质量改进,减少了患者更换腹膜透析液操作不规范,降低了腹膜透析相关性腹膜炎的发生率,尤其是革兰氏阳性菌所致腹膜炎发生率。Objective To decrease the peritonitis rate in peritoneal dialysis （PD） patients through file continuous quality improvement （CQI） program, and to analyze file characteristics and outcome of peritonitis in PD patients. Methods We adopted the four-step （PDCA） method, i.e., plan do, check, act, to design and perform the measures for reducing file prevalence of peritonitis. Eighty-six PD patients were enrolled as con- txol group not using CQI program, and 102 PD patients were recruited as observation group using CQI pro- gram. These PD patients were treated in file Peritoneal Dialysis Center, Department of Nephrology, Tongxiang First People＇s Hospital. The prevalence, clinical characteristics and outcome of peritonitis were compared between file two groups. Results Compared to control group, peritonitis reduced from 0.2093 episodes per year to 0.0980 episodes per year （χ^2=4.557, P=0.033） in observation group, and Gram-positive bacteria peritonitis reduced from 0.1385 episodes per year to 0.0490 episodes per year （χ^2=4.424, P=0.035）. Peritonitis due to in- correct manipulation of liquid change reduced from 0.1163 episodes per year to 0.0392 episodes per year （χ^2= 4.020, P=0.045）. Conclusion CQI program decreased file peritonitis due to incorrect manipulation of liquid change and file rate of PD-related peritonitis especially file rate of Gram-positive bacteria peritonitis.

关 键 词：腹膜透析 腹膜炎 持续质量改进 

分 类 号：R459.5[医药卫生—治疗学]