降低终末期肾病患者动静脉内瘘成熟不良率
发布人：yaot 发布时间：2022/12/16 11:50:17 浏览次数：1939次
【字体:
】
】——王涛 赵淑青 刘考
【摘要】目的 降低终末期肾病患者动静脉内瘘成熟不良率。方法 成立品管圈圈组，通过现状调查、原因解析明确问题真因，从制定动静脉内瘘院前指导规范，建立多学科协作模式；实施“VAP”评估模式，制定围手术期标准化管理流程；构建“互联网 +”智能宣教模式，优化院外延伸服务三方面进行改进。结果 终末期肾病患者动静脉内瘘成熟不良率由10.6%降低至3.3%。结论 开展品管圈活动降低了终末期肾病患者动静脉内瘘成熟不良率。
【关键词】品管圈；问题解决型品管圈；终末期肾病；动静脉内瘘
中图分类号：R692；R197.323 文献标识码：B
Reducing the Unsatisfactory Rate of Arteriovenous Fistula Maturation in Patients with End-Stage Renal Disease/WANG Tao,ZHAO Shuqing,LIU Kao.//Chinese Health Quality Management，2022,29(12):89-92
Abstract Objective To reduce the unsatisfactory rate of arteriovenous fistula maturation in patients with end-stage renal disease.Methods The quality control circle group was established, and the real causes of the problems were identified through the cross-sectional investigation and cause analysis. Improvements were made from three aspects. The pre-hospital guidance norms of arteriovenous fistula were formulated, and the multidisciplinary cooperation mode was established. The "VAP" evaluation mode was implemented, and the standardized process of perioperative management was formulated. The "Internet +" intelligent education mode was constructed, and the extended services outside the hospital was optimized. Results The unsatisfactory rate of arteriovenous fistula in end-stage renal disease patients decreased from 10.6% to 3.3%. Conclusion Quality control circle activity can reduce the unsatisfactory rate of arteriovenous fistula in patients with end-stage renal disease.
Key words Quality Control Circle; Problem Solving Quality Control Circle; End-Stage Renal Disease; Arteriovenous Fistula
Firstauthor's address Qilu Hospital of Shandong University, Ji'nan,Shandong,250012,China
1主题选定
全体圈员通过征求科室医护人员意见收集存在问题，从重要性、圈能力、上级重视度、达成性四个评价维度，结合“5-3-1”评分法，对所有备选主题进行打分，并引入圈外专家参与机制，确定本期活动主题为“降低终末期肾病患者动静脉内瘘成熟不良率”。
名词定义：动静脉内瘘成熟不良是指行动静脉内瘘成形术后12 w内瘘发育不良，不能满足透析需要，主要包括穿刺困难和（或）血流量不足［1］。其中：穿刺困难包括内瘘感染、渗血、血栓形成、血管狭窄等情况；血流量不足包括自然血流量≤500 mL/min和（或）透析时泵控血流量＜200 mL/min。
衡量指标：动静脉内瘘成熟不良率=统计周期内动静脉内瘘成熟不良患者例数/同期行动静脉内瘘成形术患者总例数×100%。
选题背景：近年来，慢性肾脏病发病率逐年升高，全球人群慢性肾脏病患病率高达14.3%［2］。我国18岁以上人群慢性肾脏病患病率为10.8%［3］。在终末期肾脏病的替代性治疗模式中，92.1%的患者采用血液透析治疗［4］。动静脉内瘘被认为是血液透析治疗最合适的途径［5］。病历资料回顾分析显示，山东大学齐鲁医院器官移植科2017图1改善前患者行动静脉内瘘成形术的手术及护理流程图2终末期肾病患者动静脉内瘘成形术前血管维护不充分的原因图3终末期肾病患者动静脉内瘘评估及监测不全面的原因图4终末期肾病患者动静脉内瘘成形术后功能锻炼不规范的原因年-2020年动静脉内瘘成熟不良率高达18.2%，严重影响患者透析治疗质量及生存质量，亟待改进。
……
