——屈晓玲 王颖 杨婷 周雁荣

【摘要】成立品管圈小组，通过现况把握、原因解析、对策拟定，制定SMOOTH干预模式，包括：S(Staff)-人员，推动多学科合作，共谋血栓防控；M（Method）-方法，基于循证证据，规范标准流程；O（Operate）-实施，强化专项改善，实施精准预防；O（On time feedback）-反馈，实时质控反馈，科学有效预防；T（Train）-培训，全民培训宣教，强化防控意识；H（Health information system） -信息系统，构建信息平台，助力血栓防治。实施后泌尿系统疾病患者围术期VTE发生率由2.81%下降至1.12%，促进了VTE多学科团队合作，提高了医疗质量和护理质量，保障了患者安全。

【关键词】品管圈；问题解决型品管圈；泌尿系统疾病；围术期；静脉血栓栓塞症；发生率

中图分类号：R197.323;R69文献标识码：B

Reducing the Incidence of Perioperative VTE in Patients with Urinary System Diseases/QU Xiaoling,WANG Ying,YANG Ting,et al.//Chinese Health Quality Management，2021,28(8):62-67,76

Abstract A quality control circle team was established. Through understanding the current situation,analyzing the causes and formulating countermeasures, the SMOOTH intervention mode was developed, including S (Staff) for personnel, to promote multidisciplinary cooperation and conspire thrombus prevention and control; M for Method, based on evidence-based evidence, to standardize the standard process; O for Operation, strengthen special improvement, implement precise prevention; O for on time feedback, real-time quality control feedback, scientific and effective prevention; T for training, public training and education, strengthening prevention and control awareness; H for Health Information System, building an information platform to help prevent and cure thrombosis. After the implementation, the incidence of perioperative VTE in patients with urinary system diseases decreased from 2.81% to 1.12%, which promoted the multidisciplinary teamwork of VTE, improved the quality of medical and nursing, and ensured the safety of patients.

Key words Quality Control Circles; Problem Solving Quality Control Circle; Urinary System Diseases; Perioperative; Venous Thrombosis Embolism; Incidence

First-author's address Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology,Wuhan,Hubei,430030,China

1主题选定

圈员从领导重视程度、圈能力、重要性、本期达成性四个维度，按照“5-3-1”评分法，对所有备选主题进行评价，得分第一顺位“降低泌尿系统疾病患者围术期VTE发生率”被选定为本期活动主题。

名词定义：（1）VTE（Venous Thrombosis Embolism, 静脉血栓栓塞症）。指血液在静脉内不正常凝结，使血管完全或不完全阻塞，包括肺血栓栓塞症（Pulmonary Embolism, PE）和深静脉血栓形成（Deep Vein Thrombosis，DVT）［1］ 。（2）围术期。即围绕手术的全过程，具体是指从确定手术治疗时起直到与此次手术有关治疗基本结束为止，时间为术前5 d～7 d至术后7 d～12 d［2］ 。

衡量指标：泌尿系统疾病患者围术期VTE发生率=泌尿系统疾病患者围术期发生VTE人数÷泌尿系统疾病手术患者总人数×100%。

选题背景： VTE是外科手术特图1改善前泌尿系统疾病患者围术期VTE预防作业流程别是肿瘤术后常见并发症。血液高凝状态、静脉血流缓慢或瘀滞、血管内皮损伤是VTE形成的三大要素［1,3］ 。这三种因素均可发生于泌尿外科患者。有研究显示，泌尿外科患者围术期症状性VTE发生率达1%～5%［4-5］ ，其中，前列腺癌根治切除术患者VTE发生率为0.5%～1.5%，膀胱癌根治切除术患者VTE发生率高达4.9％～5.4％［6-8］ 。VTE发生不仅严重影响泌尿外科患者临床结局，而且会导致患者住院时间延长，经济负担增加，术后康复满意度下降。因此，做好泌尿外科患者围术期VTE预防，具有重要意义。近年来，已有组织机构发布VTE防治相关指南，用于指导临床实践［9-10］ 。华中科技大学同济医学院附属同济医院泌尿外科对于VTE评估主要采用Caprini评估表，实施VTE预防措施主要包括基础预防、物理预防和药物预防，但相关措施落实情况参差不齐，尚未形成规范化流程，多学科协作不紧密，VTE预防工作也未常态化，围术期患者VTE规范化管理亟待改善。