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李墨奇 王代红 何文昌 伍薇 王沂芹 宋彩萍 王亚玲 高家蓉 陈锦
【摘 要】 目的 降低血液透析患者体外循环凝血发生率，确保患者安全。方法 成立多学科协作品管圈圈组，针对血液透析患者体外循环凝血发生进行现状调查、原因分析，从建立透析全程出凝血状态评估体系、精准确定抗凝剂剂量、规范抗凝剂使用3方面改进。结果 血液透析患者体外循环凝血发生率由4.17%降低至1.60%。结论 品管圈活动开展可整合团队优势资源，不但有效降低了血液透析患者体外循环凝血发生率，还建立了个性化透析治疗方案，更好地保障了患者安全。
【关键词】 品管圈；血液透析；患者；体外循环凝血
Decreasing the incidence of the extracorporeal circulation coagulation in hemodialysis patients
/LI Mo -qi, WANG Dai-hong, HE Wen-chang, et al.
Abstract Objective To decrease the incidence of the extracorporeal circulation coagulation in hemodialysis patients to ensure the safety of patients. Methods Through the establishment of the multidisciplinary quality control circle (QCC) team, the cross-sectional investigation and causes analysis were carried out on the incidence of the extracorporeal circulation coagulation in hemodialysis patients. The improvement was made from the following three aspects: establishing the evaluation system of coagulation state during the whole course of dialysis, accurately determining the dose of anticoagulant and standardizing the use of anticoagulant. Results The incidence of the extracorporeal circulation coagulation in hemodialysis patients decreased from 4.17% to 1.6%. Conclusion The QCC activities can integrate the superior resources of the team, not only effectively reduce the incidence of extracorporeal circulation coagulation in hemodialysis patients, but also establish personalized hemodialysis treatment scheme to better guarantee the safety of patients.
Key words quality control circle; hemodialysis; patient; extracorporeal circulation coagulation
First-authors address Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
1 主题选定
全体圈员围绕血液透析并发症预防、感染控制、用药指导、健康教育等内容列出20个需改进的重要问题，通过多重投票法确定5个候选主题，从重要性（0.255）、迫切性（0.240）、可行性（0.230）、圈能力（0.275）4个维度结合5、3、1评价法对主题进行打分，选定总分第一的“降低血液透析患者体外循环凝血发生率”作为本期活动主题。
名词定义：（1）血液透析（Hemodialysis, HD）简称血透，是指利用半透膜原理，通过溶质交换清除血液内的代谢废物，维持电解质和酸碱平衡，同时清除过多的液体 [1]。（2）体外循环凝血是指血液透析时，经抗凝处理后的血液在血泵推动下进入体外循环管路和透析器，发生溶质交换后再经体外循环管路回到体内，在此循环过程中发生透析器和管路血液凝集现象称为体外循环凝血[2]。国内外文献将体外循环凝血分为0级∽Ⅲ级共4级[3]。由于0级∽Ⅰ级凝血对患者体外循环通畅度影响较小，不影响治疗效果，本次活动将Ⅱ级、Ⅲ级凝血作为研究对象。
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