中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (11): 727-730.doi: 10.3969/j.issn.1671-4091.2018.11.002

• 临床研究 • 上一篇    下一篇

持续质量改进降低腹膜透析中心腹膜透析相关性腹膜炎

杨渊1,范为荣1,沈娟娟1,潘敏燕1,陈帼英1,陆勤勉1,金炜1   

  1. 1. 桐乡市第一人民医院肾内科
  • 收稿日期:2018-06-19 修回日期:2018-07-09 出版日期:2018-11-12 发布日期:2018-11-13
  • 通讯作者: 金炜 1039191383@qq.com E-mail:1039191383@qq.com

Continuous quality improvement decreased the rate of peritonitis in a peritoneal dialysis center

  • Received:2018-06-19 Revised:2018-07-09 Online:2018-11-12 Published:2018-11-13

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摘要： 【摘要】目的通过持续质量改进(continuous quality improvement,CQI)，降低腹膜透析(peritoneal dialysis，PD)患者腹膜透析相关性腹膜炎的发生率，分析腹膜炎的特征及结局。方法运用PDCA四步法，即设计(plan)—实施(do)—检验(check)—应用(act)，设计并实施降低腹膜透析患者腹膜炎的流程。选择桐乡市第一人民医院肾内科腹膜透析中心未进行CQI 的86 例腹膜透析患者为对照组，选择进行CQI 的102 例腹膜透析患者为观察组，分析CQI 前后腹膜透析患者腹膜炎的发生率、特征及结局。结果该中心腹膜透析相关性腹膜炎的发生率由CQI 前的0.2093 次/(患者·年)降至CQI 后的0.0980 次/(患者·年)(c2=4.557，P=0.033)；其中革兰氏阳性菌所致腹膜炎发生率由0.1395 次/(患者·年)降至0.0490 次/(患者·年)(c2=4.424，P=0.035)；PD 更换腹膜透析液操作不规范所致腹膜炎发生率由0.1163次/(患者·年)降至0.0392 次/(患者·年)(c2=4.020，P=0.045)。结论通过持续质量改进，减少了患者更换腹膜透析液操作不规范，降低了腹膜透析相关性腹膜炎的发生率，尤其是革兰氏阳性菌所致腹膜炎发生率。

关键词: 腹膜透析, 腹膜炎, 持续质量改进

Abstract: 【Abstract】Objective To decrease the peritonitis rate in peritoneal dialysis (PD) patients through the continuous quality improvement (CQI) program, and to analyze the characteristics and outcome of peritonitis in PD patients. Methods We adopted the four-step (PDCA) method, i.e., plan, do, check, act, to design and perform the measures for reducing the prevalence of peritonitis. Eighty-six PD patients were enrolled as control group not using CQI program, and 102 PD patients were recruited as observation group using CQI program. These PD patients were treated in the Peritoneal Dialysis Center, Department of Nephrology, Tongxiang First People's Hospital. The prevalence, clinical characteristics and outcome of peritonitis were compared between the two groups. Results Compared to control group, peritonitis reduced from 0.2093 episodes per year to 0.0980 episodes per year (c2=4.557, P=0.033) in observation group, and Gram-positive bacteria peritonitis reduced from 0.1385 episodes per year to 0.0490 episodes per year (c2=4.424, P=0.035). Peritonitis due to incorrect manipulation of liquid change reduced from 0.1163 episodes per year to 0.0392 episodes per year (c2= 4.020, P=0.045). Conclusion CQI program decreased the peritonitis due to incorrect manipulation of liquid change and the rate of PD-related peritonitis especially the rate of Gram-positive bacteria peritonitis.

Key words: Peritoneal dialysis, Peritonitis, Continuous quality improvement