作　　者： (张娜）; (冯文）;

机构地区： 北京市回民医院血液净化中心,北京100054

出　　处： 《中国血液净化》 2017年第8期542-546,共5页

摘　　要： 目的分析PDCA质量管理方法[即计划(plan)、实施(do)、检验(check)、应用(act)]对维持性血液透析(maintenance hemodialysis,MHD)患者矿物质代谢水平的作用与影响,完善血液透析患者的质量管理。方法本回顾性研究使用北京市某医院血液透析中心录入北京市血液净化质量控制和改进中心数据登记系统的数据进行分析。该中心于2013年1月始进行PDCA循环管理流程,研究纳入2011年1月~2012年12月(对照组)及2014年1月~2015年12月(干预组)期间稳定(>3月)且之后具有连续12个月完整临床数据MHD患者。两组患者共90例,记录一般情况(性别、年龄、透析龄、首透时间、原发病),及矿物质代谢指标[钙(calcium,Ca)、磷(phosphorus,P)、全段甲状旁腺素(intact parathyroid hormone,i PTH)]。干预组应用PDCA质量管理方法,对质量管理流程实施前后患者的矿物质代谢指标的变化进行分析和评价。采用描述性分析对数据进行统计分析。结果干预前后2组患者血钙由(2.23±0.19)mmol/L升至(2.27±0.14)mmol/L(t=1.347,P=0.178)、血磷由(1.90±0.45)mmol/L降至(1.71±0.35)mmol/L(t=-1.791,P=0.073)、i PTH由(297.63±233.25)mmol/L降至(293.46±227.44)mmol/L(t=0.049,P=0.961),但均无统计学意义。干预前后2组患者血磷波幅由(1.16±0.59)mmol/L降至(0.98±0.48)mmol/L,差异有统计学意义(t=-2.089,P=0.037)。干预前后2组患者i PTH变异性由(0.47±0.23)%降至(0.35±0.20)%,差异有统计学意义(t=-2.528,P=0.011)。干预前后2组间血钙变异性、血钙波幅、血磷变异性、i PTH波幅、异常血钙占比、异常血磷占比、异常i PTH占比无统计学差异。结论采用PDCA质量管理可改善MHD患者矿物质代谢水平,对于MHD患者的医疗服务管理有重要意义。 Objective To explore the effect of PDCA （plan, do, check and act） management on the im- provement of mineral metabolism disorder in maintenance hemodialysis （MHD） patients in order to improve quality management for hemodialysis patients. Methods Since Jan. 1st, 2013, the PDCA, a 4-step problem- solving frame work of continuous quality improvement （CQI）, was carried out for the management of mineral metabolism disorder in MHD patients who were stable for more than 3 months in one hospital in Beijing. A to- tal of 90 MHD patients treated in the hospital with complete clinical data within 12 months from Jan. 2011 to Dec. 2012 （control group） and from Jan. 2014 to Dec. 2015 （intervention group） were enrolled in this study. Clinical characteristics and mineral metabolism parameters including serum Ca, P and intact parathyroid hor- mone （iPTH） were extracted from digital clinical record system. Variability and mean of the parameters were calculated. Changes of mineral metabolism parameters were compared between the two groups. Results In intervention group and control group before PDCA management, serum Ca increased from 2.23±0.19 mmol/L to 2.27±0.14 mmol/L （t=1.347, P=-0.178）, serum P decreased from 1.90±0.45 mmol/L to 1.71±0.35 mmol/L （t=-1.791, P=0.073）, and serum iPTH decreased from 297.63±233.25 mmol/L to 293.46±227.44 mmol/L （t= 0.049, P=0.961）. These changes had no statistical significances. After the intervention, the variation of serum P between the two groups decreased from 1.16±0.59 mmol/L to 0.98±0.48 mmol/L （t=-2.089, P=-0.037）, the coefficient of variation （CV） of serum iPTH between the two groups decreased from 0.47±0.23% to 0.35± 0.20% （t=-2.528, P=0.011）. The mean, range and CV of serum Ca, the mean and CV of serum P, the mean and range of serum iPTH, and the abnormal ratio of serum Ca, P and iPTH were similar between the two groups.Conclusions PDCA management improves mineral metabolism in MHD patients, and is thus useful for the management of

关 键 词： 管理 血液透析 矿物质代谢 变异性