PDCA循环法及根本原因分析法在持续正压通气治疗重症肺炎患儿中的应用效果  

Application of PDCA circulation method and root cause analysis method in the treatment of severe pneumonia in children with continuous positive pressure ventilation

作　　者：庄江兰 杨美菊[1] 沈美丽 张琴华[1] 吴清坦 李翠娥[1] ZHUANG Jianglan;YANG Meiju;SHEN Meili;ZHANG Qinhua;WU Qingtan;LI Cui’e(Department of Pediatric Intensive Care Medicine,Quanzhou Women and Children’s Hospital,Quanzhou 362108,China)

机构地区：[1]泉州市妇幼保健院(泉州市儿童医院)儿童重症医学科,福建泉州362108

出　　处：《广州医药》2024年第2期157-163,共7页Guangzhou Medical Journal

摘　　要：目的探讨计划-实施-检查-处理(PDCA)循环法及根本原因分析法在持续正压通气治疗重症肺炎患儿中的应用效果。方法选取2021年1月—2023年1月医院收治并接受鼻塞式持续正压通气治疗的重症肺炎患儿80例,基于随机数字表法分为两组,每组各40例。对照组接受常规护理,观察组采用PDCA循环法联合根本原因分析法护理干预。比较两组临床症状改善时间、血气指标[动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、肺功能指标[第1秒用力呼气容积(FEV_(1))、潮气量(VT)]、炎症免疫指标[单核细胞趋化蛋白-1(MCP-1)、可溶性髓系细胞触发受体-1(sTREM-1)、可溶性细胞间黏附分子-1(sICAM-1)]水平变化,比较两组患儿家属满意度情况。结果观察组患儿咳嗽、气促、哮鸣音、心率恢复及紫绀等症状改善用时均低于对照组,比较差异有统计学意义(P<0.05)。干预前,两组患儿PaO_(2)、SaO_(2)、PaCO_(2)、FEV_(1)、VT、MCP-1、sTREM-1、sICAM-1水平比较差异均无统计学意义(P>0.05);干预后,两组患儿上述指标水平均有不同程度变化(P<0.05),观察组PaO_(2)(97.18±7.90 mmHg vs90.30±7.12 mmHg)、SaO_(2)(93.58±3.82%vs 86.30±4.21%)、FEV_(1)(2.66±0.46 L vs 1.97±0.34 L)、VT(11.92±1.89%vs 9.83±1.10%)水平均高于对照组,观察组PaCO_(2)(36.70±3.97 mmHg vs 40.65±3.79 mmHg)、MCP-1(58.45±11.94 ng/L vs 74.46±16.69 ng/L)、sTREM-1(36.25±8.30 ng/L vs 51.57±9.51 ng/L)、sICAM-1(187.52±31.22 mg/L vs243.73±46.79 mg/L)水平低于对照组,差异均有统计学意义(P<0.05)。观察组患儿家属满意度整体优于对照组(P<0.05);观察组总满意率(97.5%vs 77.5%)高于对照组,差异有统计学意义(P<0.05)。结论PDCA循环法及根本原因分析法应用于接受持续正压通气治疗的重症肺炎患儿,能够有效促进患儿临床症状改善,有利于血气及肺功能恢复,且可降低炎症反应,患儿家属满意度较高。Objective To explore the application effect of Plan-Do-Check-Action(PDCA)circulation method and root cause analysis method in the treatment of children with severe pneumonia with continuous positive pressure ventilation.Methods From January 2021 to January 2023,80 children with severe pneumonia who were admitted to hospital and received nasal plug continuous positive pressure ventilation treatment were enrolled in this study.Based on the random number table method,they were divided into two groups,with 40 cases in each group.The control group received routine nursing,while the observation group received PDCA circulation method combined with root cause analysis nursing intervention.The improvement time of clinical symptoms,changes in blood gas indicators[arterial partial oxygen pressure(PaO_(2)),arterial oxygen saturation(SaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))],lung function indicators[(forced expiratory volume in 1 second,FEV_(1)),tidal volume(VT)],and inflammatory immune indicators[monocyte chemotactic protein-1(MCP-1),soluble myeloid cell trigger receptor-1(sTREM-1),soluble intercellular adhesion molecule-1(sICAM-1)]levels between the two groups were compared,and the family members’satisfaction of the two groups was also compared.Results The improvement time for symptoms such as cough,shortness of breath,wheezing,heart rate recovery and cyanosis in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Before intervention,there was no statistically significant difference in the levels of PaO_(2),SaO_(2),PaCO_(2),FEV_(1),VT,MCP-1,sTREM-1 and sICAM-1 between the two groups of children(P>0.05).After intervention,the levels of the above indicators in both groups of children showed varying degrees of change(P<0.05).The levels of PaO_(2)(97.18±7.90 mmHg vs 90.30±7.12 mmHg),SaO_(2)(93.58±3.82%vs 86.30±4.21%),FEV_(1)(2.66±0.46 L vs 1.97±0.34 L),VT(11.92±1.89%vs 9.83±1.10%)in the observation group were higher than those in

关 键 词：重症肺炎 持续正压通气 PDCA循环法 根本原因分析法 应用效果 

分 类 号：R725.6[医药卫生—儿科]