PDCA持续质量改进在降低ICU患者气管插管拔管后48 h内再插管率中的应用效果  

Application effect of PDCA continuous quality improvement in reducing the rate of recanalization within 48 h after endotracheal intubation in ICU patients

作　　者：朱亚容 蒋勇[1] ZHU Ya-rong;JIANG Yong(Department of Intensive Medicine,Yingde People's Hospital of Guangdong Province,Yingde 513000,China)

机构地区：[1]广东省英德市人民医院重症医学科

出　　处：《中国当代医药》2019年第21期67-69,共3页China Modern Medicine

摘　　要：目的评价PDCA持续质量改进在降低ICU患者气管插管拔管后48h内再插管率中的应用效果。方法我院ICU于2018年1月开始应用PDCA持续质量改进解决撤机后再插管问题,选取PDCA持续质量改进前后ICU收治的719例机械通气气管插管患者作为研究对象,其中2017年1~12月(改进前)ICU收治的患者404例,2018年1~8月(改进后)ICU收治的患者315例。比较PDCA持续质量改进前后ICU患者的48h内再插管率、延长撤机率,Ⅲ级浓痰、呼吸机相关性肺炎、气道黏膜出血/呛咳发生率以及机械通气时间、吸氧时间。结果PDCA持续质量改进后,ICU患者的机械通气时间、吸氧时间短于改进前,差异均有统计学意义(P<0.05)。PDCA持续质量改进后,ICU患者48h内再插管率、延长撤机率、气道黏膜出血/呛咳率的发生率均低于改进前,差异有统计学意义(P<0.05)。PDCA持续质量改进前后ICU患者的Ⅲ级浓痰发生率、呼吸机相关性肺炎发生率比较,差异均无统计学意义(P>0.05)。结论PDCA持续质量改进可以有效降低ICU患者气管插管拔管后48h内再插管率。Objective To evaluate the application effect of PDCA continuous quality improvement in reducing the rate of recanalization within 48 h after endotracheal intubation in ICU patients.Methods In January 2018,the PDCA continuous quality improvement had been applied to solve the re-intubation problem after withdrawal of ICU in our hospital.All of 719 patients with mechanical ventilation tracheal intubation treated in ICU before and after PDCA continuous quality improvement were selected as the study objects.From January to December 2017(before improvement),404 patients were treated in ICU,and from January to August 2018(after improvement),315 patients were treated in ICU.The rate of re-intubation within 48 h,the rate of prolonged evacuation and the incidence of degreeⅢintensive phlegm,ventilator-associated pneumonia and airway mucosal hemorrhage/cough,the mechanical ventilation time and oxygen intake time before and after continuous quality improvement of PDCA in ICU patients were compared.Results After continuous quality improvement of PDCA,the mechanical ventilation time and oxygen inhalation time of ICU patients were significantly shorter than those before improvement,and the differences were statistically significant(P<0.05).After continuous quality improvement of PDCA,the rate of re-intubation within 48 h,the rate of prolonged evacuation and airway mucosal hemorrhage/cough in ICU patients were significantly lower than those before the improvement,and the differences were statistically significant(P<0.05).There were no significant differences in the incidence rates of degreeⅢintensive phlegm and ventilator-associated pneumonia in patients with ICU before and after continuous quality improvement of PDCA(P>0.05).Conclusion Continuous quality improvement of PDCA can effectively reduce the rate of recanalization within 48 h after endotracheal intubation in ICU patients.

关 键 词：ICU 气管插管 重复加机 PDCA 质量改进 

分 类 号：R197.323[医药卫生—卫生事业管理]